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FROhI : PHASE ONE EN 1041-ENTAL INC PHONE NO. : 209 5F" 1295 P02 <br /> �-- 1 u <br /> uu <br /> Ell 00 14 JREV 5194) SAN JOAQUIN COUNTY: <br /> PUBLIC HEALTH SER'VICFrs <br /> i ENVIRONNI:ENTAL 11FALni DWISION 1 <br /> i ptmLIC RECORDS RELEASE APPLICATION <br /> I �c yI R �Q✓z S4Iv P NS NO (7��5(07 -077 <br /> APPlr1C . _'- <br /> pDDms I �`13T der ierv�all A -rl x C32f PION& NO <z'4J 4 bS 3�t z0 <br /> AGF*CY AMB `SsZ �uS £riI> <br /> 'ADl?li1rSS <br /> ��r�KTOnl, r_pAI� AflHNCY' DATE <br /> 0 1�1 I lntt3 8 ST q�_ SSC-V t{5-E tI A <br /> © Pq,J.r.. aa. zb-e GknRYce- WAY. <br /> 'AIA AJC a - lOSQ"UTAMD,.Ja ST' U _ 4 _ 4 <br /> eoE►LL F � �srlu� _ <br /> 7 <br /> -IRIS NOTICE IS SUvr6CT TO THE JCEQUIRJIMENTS IDENTIFIED IN THE PUBLIC: HEAI.'CH <br /> SGRVIOES/EN 7JRONR,JgNTALjJEALTH DIVISION (EHD)POLICY 4Q4-007,ORDINANCE C09E OP SAN <br /> JOAQUIN COUNTY. END FEES AND SERVICE CHARGE RHSOI'_UTIONS, STATE WA-11:K cuDI:, <br /> COVERNJ.l1;NII�CODH AND THE HYIDBNCE CODE. <br /> 1. A MAkwUM Of TEN (19)PAUMISS ADDRESSS4 PER SSQUCOT. <br /> 2. •PUBCI }TILLSIIR ��CORDS REVIEW 14 BY APPOINTMHNT ONt:T. APPOINTMENTS ARZ ARRANOEO BY <br /> CALUNO (10 )468-034a OFFICY HOU" FOR APPOUJTUmm AAS .SCI;LDVLTiD MONDAY TNRU FRIDAY <br /> ID(CLUDINO JOUDAYS, 6:40 AM TO 12:00 NOON ANDf1:00 PM Tv 4:a0 Pal. <br /> r <br /> 3. A P0B'IC RTi dsm RLLLASB APPLICATION (MA)U REQumD.' <br /> 4. Pumj,cI'FIhBS/RLCORDS NOT IISTUANBD W TTIB IAMB CoNDIr111N A3 RECEIVED WILL Be CORRECTED <br /> 8Y 7HB FID;BiAFp AT'EII$ LXPENPa Op TIL4 AEPL1CANi'. TNp ADDITIONAL SERVR;L WILL BB BILLED TO THE <br /> APPLICAW Mn IAYbIWt. (SEB VID POLICY 94L007) ; <br /> I <br /> S. ORIGIN F PUBLIC.Vl LEVPSCORDS swALL NOT BS mwiv EU mim TNS FHD PREMISES\ <br /> SIONA'JUR9 0 APPLiCANi"T�f cI L . ,�; DATE OI C�8/?'1.' <br /> SIONATURgflF RELEASING OYPICI / VJDATE I' ON�—�I <br /> Na pFlS/6IiD RJ coags/PILra An IbP.mvmz): <br /> PHSIEHD RE,CDRW ITILa+ a=r ON THE ADDAEST(ES)NOTED. YOU WIL BC NOJIPIED wIIEN <br /> Rt CDRTIs/F11 S AAL AVAIL Ul L tON ASViEw; <br /> •a,v I kns✓1s m Raw.v qne J <br /> i <br />