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Ell VU 14 (RE V 5/94) SAN JOAQUIN COUNCY <br />PUBLIC 11EAL'I7I SERVICES <br />ENVIRONMEN AL IIFAL'1'II DIVISION <br />[PUBLIC RIPCORDS RELEASE APPLICATION <br />APPLICANTe_ gohip iqn .PHONE NO <br />ADDRESS <br />AGENCY NAME t rO 2 (rn S oc I J PIWNB NO Z�oQ <br />ADDRESS ! `> w 0 ClIr <br />PILE ADDRESS LEAD &GENCY DA'L'E <br />1 331 S Hgfy-) tgY)-:� 'fl-) z I l <br />7 - <br />"IIS NOTICE IS SUWU(7P TO THE REQUIREMENTS IDENTIFIED IN WE PUBLIC HGiALTH <br />SERVICESIENVIRONMENTAL HEALTH DIVISION (E -HD) POLICY 494-M7, ORDINANCE CODE Qr SAN <br />JOAQUIN COUNTY, EHD FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br />GOVERNMENT CODE AND'ME EVIDENCE CODE. <br />I, A MAXIMUM OF T>;N (10) PREMMIS AbDRE9s6a" PER REQUCiSr. <br />2. Punic FTLES/RECORDS REVIEW Is 8Y APF'OINTMENTOLyLY• APPOIrcImSNIs AItB ARRANbBD E> <br />CAI_I-INC (209468-0340. OFFICE IrouRS rOk AMINTMENTS ARE SCI(EDVI-EO MONDAY TIFRU t�.RIDAY <br />E,,(CLUDINC HOUDAYS, 8:00 AM TO 12:W NOON AND 1:00 PM To 4:30 PM. <br />�. A IPURLIC RscoRb9 RM.FASS APPLICA'T'ION (PRRA) 13 MQUIRM. I <br />4. PUBLIC FIL ESIRECORDS NOT Rk"rURNED IN TIIE SAME CONDfIION AS RECEIVED WILL 88 COKf6crED <br />BY TIIE CMD STAFF A -r "s I:XPRNS9 OF THE APPLICANT. TmS ADDmONAL SFRYI(M WILL 014 BILLED TO THE <br />APPLICANT FOR PAYMBNT. (SEI' EHD POLICY 94-(A)7) <br />5. ORIVINAL Punuc IZLES/RECORDS SFIAI.L NOT Bg XwoVm FRon( THM3 C3ID PRF -midis. <br />SICNATURU OF APPUCANT (� DA'TC <br />SIGNATURE OF RELEASING OFI7CIAI. DATE <br />NO PHS/EHD REC0RD3/i'IL&3 ARE IDENTIFIED: <br />t)—M lwrs to ?%TT anon ILUR <br />PHSIEHD R&CORD3/I'IL0 sZIST ON TIM ADDRF_US(ES) NOtED. YOU'WILL B8 NOTIFIFM W119N <br />RECO",VFILES ARE AVAILABLE FOR REVIEW: <br />Imm. awl~" Or. rbnpk:mr nw r)A71h. <br />