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q'y-- U�7v <br /> LG" <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT,_ � n _n-�-- _ Ii�C K rf1 w-/ PHONE NO_YI� <br /> ADDRESS I <br /> AGENCY NAME ( PHONE NO <br /> ADDRESS I <br /> FULL ADDRESS BUSINESS NAME/ PROGRAM OR <br /> FACILITY TYPE OF FILE <br /> f Ir -w' 11 <br /> q _5 0 a. 1) <br /> y J c h ,. Ccfr'Ll_ �t'11Cc.t1 <br /> I <br /> I <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICESIENVIRONMENTAL HEALTH DIVISION (EHDi POLICY 1194-007, ORDINANCE CODE OF <br /> SAN JOAQUIN COUNTY, EHD FEE AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1. A MAXIMUM OF TEN (0) PREMISE ADDRESSES PER REQUEST <br /> 2. PUBLIC FILES/RECORDS REVIEW IS BY APPOINTMENT ONLY. APPOINTMENTS ARE PROCESS- <br /> ED BY CALLING {2091468-3420. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED MONDAY <br /> THRU FRIDAY EXCLUDING HOLIDAYS, 8:00 AM TO 121 00 NOON AND 1:00 TO 4:30 PM. <br /> 3. A PUBLIC FILES/RECORDS RELEASE APPLICATION (PRRA) IS REQUIRED. <br /> 4. PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> ` SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. (SEE EHD POLICY 94- 007) <br /> 5. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> aaastataa+s+a+asaaataa+a+++s+++tact+taaaa a+++t+s+++ata+a++++a+aataaaaaaaaaa <br /> SIGNATURE OF APPLICANT { DATE <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 9196) <br />