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SAN JOAQUIN COUNTY �� 7yS-ISI <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION U 3 v <br /> PUBLIC RECORDS RELEASE REQUEST FORM <br /> INDIVIDUAL NAME'T�\o rna-, J `/a IC-V-\ PHONE NO -: - 359 E <br /> ADDRESS 1Zp S e Ll B 3 , CF , <br /> AGENCY NAMECo PHONE O Sarn2 <br /> ADDRESS <br /> rP <br /> FILE ADDRESS Pc1� `� (LEAD ENFORCEMENT DATEOF <br /> �.1 AGENCY REQUEST <br /> Z22 � • EI �ocaclo S+- C .yRy)f�CbSile ct�de 9s4b R-2-9� <br /> J . on LUP: 5i cock.: zoDS <br /> LI Z. • Lcrcolr, S1 . C\JP (vc'b' S'l4,u 4a-. 9Z5y <br /> Lf j 1 ul of r�t<<� SS E H /-1V 1.S I�e Ncx� 116345 <br /> 4zy ti- fan 31,1rF,n Sfi. L 51le zS-� <br /> t5 L4 \,J , W eV�e.r s fi. 93 " <br /> F,6hW . Weh�rS1-. nrnol�s�e ; S�IeC� ' 9'.x1 �' <br /> I <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 091-001. <br /> SIGNATURE OF REQUESTING PARTY DATE z�S <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 3/91) <br />