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n•�;15.. ,°-3 1n:cf <br /> SAN Jo.40UIN COUNTY <br /> PUBLIC BJEALTH SERVICES nn <br /> EN'YIRONMENI'A1, izEAL,'ITI llIVISIQfV ict Ie- KPVI tJ <br /> PUBLIC RECORDS RELEASE REQUEST FORM q(v _ 0 30 <br /> I.N17(VIDUAI,NAMEPHONE NoQa9) S,�/ - 07/ADDRESS e PHONE No <br /> AGLNCY NAME �� . <br /> An0RFSS <br /> 'F <br /> All addresses a.r— ir'i 17larr4,Cra <br /> FII. _ADDRESS lip FNFnRCELNEh9 <br /> AGENCYRlEUEST <br /> orll 'L//-,dCy' <br /> ,;7S <br /> mn lin S <br /> on S LI1lcsin �v�. 4 Pr p� �,v <br /> 171nnra <br /> gas Illoi—�1t - s1„ca Pun <br /> CC L <br /> Snn Jongnin G-unry public Health Services Enviroomence!Henith I)Ivision lites are considered public 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 subfect to charges estabilshed L-t Sen Ioaquln County Rules and <br /> Regulation Environmental Health Permit Fees and Services Charges. <br /> Charges for records or documents requested by subpoena duces tecum are subject w changes established in <br /> the Evidence Code_ <br /> photo copies of public documents are subject to Public Records Policy #91-W1" <br /> SIGNA-MIRE OF RLQIJEST1NG PARTY DATE a /S (p <br /> SIGNATURE OF RELEASING OFFICIAL, DATE <br /> EH 00 14 (REV 3/91) <br />