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���Jam—���� I✓-J-�,L!-ll � (�I NV V HI Vt..LL' Vl�Vll � S i\1,,.iI c.lu�J 4V v - n _ <br /> SAj JOAQUIN -COMITY , <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DI`TISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> .� PHONfi i�O�Cq - Llb7- 1go 6 <br /> A)-)t-)PEsS�n�S 11/fR J W.a-r C'-T K�� _Sc3 �f,Z O 7 <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> i'tam*t � k+#+� � +' M##AFI.4###,1 ###*#*+r#t* k+r## k##**##kfr # k•4*##t#+t####M'#tt## <br /> FULL A17DP.E5? BUSINESS IVRME/ PROGRAMOR <br /> I~ACILI—TY TYV8 OF FILE <br /> r,�y/ L�10 R 1��i1, 1 ree} ,lUt N <br /> 1aW5 �R71} c91 $* E JAn! Irarno <br /> A J <br /> q tPi RNTfC►q �Rtt�rcl \liil±�I—V:}zliltir-C �� <br /> 1150 At„Q-TN /\I A i'o s fJ s fic z <br /> c� <br /> L'� ,�Irt �f.81,2�inct .T11'l�c_ze�Pt , <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICESIENVIRONMENTAL HEALTH DIVISION IEHDI POLICY J194-007, ORDINANCE CODE OF <br /> SAN JOAQUIN COUNTY. EHP FEE AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE. <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1 . A MAXIMUM OF TEN LBJ PREMISE ADDRESSES PER RECUEST <br /> 7, PUBLIC FILES/RECORDS REVIEW IS BY APPOIIVTMT ONLY. APPOINTMENTS ARE PROCESS-N <br /> ED BY CALLING 1209!468-3424- OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED MONDAY <br /> THRU FRIDAY ENCLUDING HOLIDAYS, 6:00 AM TO 12:00 NOON AND 1:00 TO 4;30 PM' <br /> 3- A PUBLIC FILESIRECORDS RELEASE APPLICATION IPRRA) I5 RIrQUI>REI7- <br /> 4- PUBLIC FILES/RECORDS NOT RETURNEQJN TIRE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE E'-ID STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. (SEE EHO POLICY 94- 007) <br /> 5. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE EHO PREMISES. <br /> ........_ ... ........ ................................ ..«,,. <br /> SIGNATURE OF APPLICANT DATE r <br /> SIGNATURE OF RELEASING OFF16A ' I ' IL'dvW/j DATE <br /> EH 00 14 (REV 9/961 <br />