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SAN JOAQUIN COUNTY _ <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE REQUEST FORM <br /> INDIVIDUAL NAME PHONENO 7 <br /> ADDRESS 7'7'7 Sc) f7� /-A17F i5'N <br /> AGENCY NAME L o c C,g 9s a Vy PHONE NO <br /> ADDRESS/i7-7-c-,-,-7,,,it .' /c�,�, 02 <br /> FILE ADDRESS LEAD ENFORCEMENT DATE OF <br /> AGENCY REQUEST <br /> 7� -/7S .J/�c/c%ove Sai 7—i3-S� <br /> I't <br /> 12 1991 <br /> L - <br /> � Ile, xv esu/ <br /> ax <br /> San Joaquin County Public Health Services Environmental Health Division files are considered publt records <br /> except for certain documents identified in the Government Code and the State Water Code. <br /> Requests for public records or file reviews are subject to charges established in San Joaquin County Rules and <br /> Regulation Environmental Health Permit Fees and Services Charges.—.,,,,2 _ <br /> Charges for records or documents requested by subpoena duces tecum are subject to changes established in <br /> the Evidence Code. <br /> Photo copies of public documents are subject to Public Records Policy #91-001. <br /> SIGNATURE OF REQUESTING PARTY��aw-gam i,- d,,?A-1 DATE <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 3/91) <br />