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• SAN JOAQUIN COUNTY _ <br /> PUBLIC HEALTH SERVICES • � <br /> ENVIRONMENTAL HEALTH DIVISIONG 3� <br /> PUBLIC RECORDS RELEASE REQUEST FORM <br /> INDIVIDUAL NAME 9TV4et,) Cl�laRk PHONE NO <br /> ADDRESS P'0 '7OD9.5 ST I<Tp,, Ca qS2,6 '1 <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> FILE ADDRESS LEAD ENFORCEMENT DATE OF <br /> AGENCY REQUEST <br /> 11940T) W . HWy 99 - �7 gl4s <br /> s . 7Cd. N, eg I,OQI <br /> 3 lAD R RD <br /> Sca c Icc UtJ A <br /> u <br /> IIII 28199 <br /> I <br /> PERMMENTALHEAL( <br /> ITI 'Ei� c <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 Coda <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 ducat tecum are subject to changes established in <br /> the Evidence Coda <br /> Photo copies of public documents are subject to Public Records Policy #91-001. <br /> SIGNATURE OF REQUESTING PARTY DATE `JS <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 3191) <br />