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16/29/1997 1h:22 E8t 'IL89yi - ..n-o u,...- - - -__ - <br /> TD 1606231899'7 P.01 <br /> 10-29--1997 91:L6FM JM .� — -- ---_-- <br /> FA Av_ccu� <br /> f <br /> SAN TOAQUIN COUNTY <br /> i PUBLIC HEALTR SERVICES <br /> WvIRONMMMTAL HEALTH DIVISION . <br /> 1 PUBLIC RECORDS RELEASE APPLICATION <br /> PHONB NO (ioCa 3 3 3 G <br /> APP I;ICA.NT -�Z �_ -- --- A tib <br /> ADD S !(n W A� �^� o HONE NO <br /> AGE NAME -�a�--� ��G <br /> ADDRESS <br /> *#};##4iY kYYYYYYY##Y*+###*Rt##YY*#*t****#♦#+4ff**Y♦#i*fiafitaat**#t <br /> FQh AADRESS_ BUS4 NAME/ PROGRAM OR <br /> FACLI"£Y _ �C` a.., TYPE OP ATY,Pa S� <br /> I 1 ^ (R{n1 bn1 <br /> c- ZIA <br /> .I <br /> 44 <br /> inA <br /> 16fnoI / 1,'l N11M.� S'i►.� x `;iq <br /> ( <br /> THIS IiOT10E IS SUBJECT TO THE REQUIREMENTS IDENT1FTED IN THE PUBLIC HEALTH <br /> SERVI+CES/ENVIRONMENTAL HEALTH DIVISION IEHD) POLICY 394-007, ORDINANCE CODE OF <br /> SAN JOAOUIN COUNTY• EHD FEE AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCF. CODE. <br /> 1. A MAXIMUM OF I'CN Ltm PREMISE ADDRESSES PER REQUEST <br /> Z. PIjEUC FILESM11CORDS REVIEW IS BY APPOIN E T ONLY. APPOIN WENTS ARE PROCESS- <br /> ED 81' CALLING 12091468.3420, OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED MONDAY <br /> THRUI.FRIDAY EXCLUDING HOLIDAYS, 8:00 AM TO 12:00 NOON AND 1:00 TO 4:30 PM. _ <br /> 3. A FVELIC FILESIRECORDS RELEASE APPLICATION 1~113 REQUIRED. <br /> 1 4. P ELIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> COR CTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERV;CE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. (SEE ERD POLICY 94-007) <br /> 5. OJIGINAL PUBLIC FILESAECORDS SHALL NOT BE REMOVED FROM THE END PREMISES. <br /> SIGN TURt: pF APPLICANT ..r �1.�' DATE 7() 1•�� <br /> SIGNITURE QE RELEASING OFFl ✓ n/�ATE <br /> EH o0 14 (REV 9196) <br /> ST <br /> f,�s �]J� �� <br /> ' jQ al�/�/�s•1JJ_Ln. '{`C'L`rJ+�•J�. a^+tx`� �.(r--' l �•�^.'�,c.�t-S TD7TL P.91 <br />