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• SAN JOAQUIN COUNTY (� <br /> PUBLIC HFALTH SERVICES <br /> ENVIRONMENTAL HFALTH DIVISION <br /> PUBLIC RECORDS RELEASE REQUEST FORM <br /> INDIVIDUAL NAME �a! f/yL4, tI6 /e4�I,�� PHONE N06�) 345700v <br /> ADDRESS Lam- kGC.e � aVc=_ 'f-t-OV15 c� <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> FILE ADDRESS LEAD ENFORCEMENT DATE OF <br /> AGENCY REQUEST <br /> ( 1 l 1 rJAVy 'pe.; szzzKlz*J li <br /> �t Z4 C tv-aV Y c7Q � s�KroN -' <br /> �J 3 '3 t.tA.V"Y,�� 9Tix K TDn! <br /> ZC� s. I '�TLSG(I uU �4V• S izK K-ttki � <br /> e 3� W • cWGZTLrIE. u.•�Y sCZCZ-aJ ;�',� ��-� <br /> tCs45 W-�V�aEyYLw'g`/ SZLI�"c7r/ r <br /> 1 I Z.J W G+{pdL7 yLWAY 57aC4e---2?,J <br /> 1l4 S w. e_HppTZX w'�y s i✓CcKTDy i <br /> UJ• C�W'7z'TL2 :5-�RYV <br /> S I S '� - C=fjPdL77•_'2w�N S�tirc;�r✓ <br /> 1 4kS 7 L 1 f-JCZ -AJ -5'1 - 57-C6<TL'tJ <br /> C 100 4 1uAV T)('� . 5 K N <br /> Sfzs N-'ivy --Tzx.KzKj <br /> San Joaquin County Public Health Services Environmental Health Division files 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 subject to charges established in San Joaquin 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 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 PAR - /DATE d 1 L S <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 3/91) <br />