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Ell UO 11 (REV 51Y4) &404 JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES �( LLtfCPtJ <br /> �r6WIRONhIENTAL HEALTH DIvM6N o ,/ ` � <br /> PUTILIC RECORDS RELEASE APPLICATION �(u� <br /> APPLICANT Ten LQ karw:atwN PHONE NO zikI - 35G-7- <br /> ADDRE�S�Lo Nww, weer? -cmla�. GR q :9121 c <br /> AGENCY NAME S PHONE NO zcxi eik x -2 tn7 <br /> ADDRESS_ r7 VQ <br /> 1 <br /> I <br /> ELF, ADDRM LEAD AGENCY jDATS <br /> L7.14 [.cL,k�o n <br /> �r �f w tr lr .�egyLH 10 . 1�rctc.y i <br /> f <br /> f <br /> i <br /> 7FIS NOTICE 13 SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE 13UC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION (EHD)POLICY $94-007, ORDINAN .CODE OF SAN <br /> JOAQUIN COUNTY, E14D PEES AND SERVICE CHARGE RESOLUTIONS, STATE I+VVATE. CODE. <br /> OOVERNMENT CODE AND THE EVIDENCE CODE. <br /> c <br /> 1. A MAXIMUM OF T EN (I4) PREmin AcoRzsses PFJI RMUERT. - <br /> 2. PM1auc FILESIRECORDS REVIEW IS IT APPOiN i MENT_Q=. APS " AAWANOCD BY <br /> CALLING (209*8-0340. OV.Y= HovBS FOR AFMINtMzxra ARS SCITEDULE6 MDNO Y THRU FRIDAY <br /> EXCLUDING HOUDAY3, 4:00 AM Te 12100 NOON AND 1.00 PM TO 4:30 PM. <br /> 3. A A na vv= RECORRELEA39 APPLICATION (PRRA)IS REQUIRED. . <br /> 4. Pusuc FILESIRECORDS Nor RETURNED IN THE GAMS CWM71014 AS f1WW9D WI`L EE CORRECSSo <br /> BY THE I±HD STAFF AT THE VUWSB OF THE APPLICANT. FHA ADMI10NAL ARKi es WILL a a1LLSD To TAX <br /> APPLICANT FOR PitYMCKY. (SEH END POLICY 04-OO7) <br /> 5. ORIGINAL PUSLIC FILEWRECORDS SHALL NOT BE REMOVED FROM THS SIM PASUiiIES. <br /> SIGNATURE OF APPLICANT - � DAA I L t <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> i <br /> No PHSIEHD REcoRbsIrMw ARE IDENTWMV: <br /> titin: u.a.m►rr Wwxinoe iMn: ' ' <br /> 1 - <br /> PHSfEHD RZZOAl S/p1LeS RXIST ON'1118 Avc*M(as)NMFD. YUU %'LL FE NM7dnm WH T.4 <br /> RECORDSMLT3 ARE AVA:LABLS roll R$VIZW: ' <br /> I <br /> i <br />