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1'IYII—In-1JJG 1C1•_ry 1 . u_ un. . .�._.�.. .. .... <br /> I,UIILIC IIEALTII SERVICES <br /> (1 `'t.NVIRONAIENTA.L 11FALT11 DMS70N <br /> PUBLIC RECORDS RELEASE APPLICATION - <br /> APP C _ A- -Ialt PHONE NO <br /> ADDRESS I°Ti 12.L.k�— QJT k h c17,r` 1 - �68• 7,0%1 <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> FILE ARD RFaS LEAD AGENCX DATE <br /> 111 )V- n'wt ST <br /> Gil E IL I �w As+� I 0 <br /> loon `c . G(•�,.w�e 1 ti' S .____ <br /> 2'08 1, C(og,�,,t 1' <br /> THIS Na"CE IS SUBJECT TO THE REQUIREMENTS IDEM 1FIED-IN THE PUBLIC HEALTH <br /> SERVICS!7/ IRoNMENTALHEALTH DIVISION(ERD)POLICY#94.007,ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY. EHD FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODS AND THE EVIDENCE CODS. <br /> I. A MAXIMUM OF TEN (10)MEMISE ADDRBSSES PER REQUEST. <br /> 2. PUBLICFILES/RECORDSRE VIEW IsSYAI'POINTNIENTONLY. APPOINTN(ENTI&PSARRANCFDBY <br /> CALLING (209)/63.0340. OFFICE 11OURS FOR APPOINTMENTS ARE SCHEDULED MONDAY THR.0 FRIDAY <br /> EKCLUDINO HOIADAY5, 3:00 AM TU 12:00 NOON AND 1:00 PM TU 4:30 PM. <br /> 3. A PUBLIC RECORDS RELBASE APPLICATION (PIIRA) IS REQUUI6D. <br /> 4. PUBLIC FILES/RECORDS NOT kmmNED IN 'Ins SAM5 CONDITION AS R6CFlvsO wIL1 BE CORRECTED <br /> BT THE EliD STAFF AT THE EXPBNS8 OP THE APPLICANT. THIS ADDITIONAL SERVICE WILL BE BILLED.TO THE <br /> APPLICANT IFOR PAYMENT. (SEE END POLICY 44-007) <br /> S. ORIGINAL PUBLIC FILF.S/RECORDS SHALL NOT BE REMOVED FROM THE END Ml."SP3- ' <br /> SIGNATURE OF APPLICANT DATE '' nn rS4 <br /> SJONATTJ EOF RELEASING OFPICI DATE <br /> No PHS/PHD REcoRO3/FdF3 ARE IDPWIFIED: <br /> R..m �+• n• tkmrw•wwR D+rr. <br /> PHS/EHD RECORDS/FILES EXIST ON THE ADURES3(F3)NOTED, YOU IYTLL BE NOnnED WHEN <br /> RECORDSlFILE3 ARE AVAILABLE FOR RETIXW-: <br /> Q.R RR'9wN wT. KnbcwT Rk <br /> TOTAL P.02 <br />