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w1 l ! I�iA �L <br /> EII 00 14 (REV 519,1 SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES ��•�/��W-�-r%v r�" [,;z(o 3 <br /> L',NVLRONMENTAL IIL'AL'111 DIVISION <br /> I'UI3LIC RECORDS RELEASE APPLICATION <br /> APPLICANT .)2 <br /> PHONE NO <br /> ADDRESS <br /> AGENCY NAME /`C� Un r -S dC/u S PI�.,ONIE NO <br /> ADDRESS <br /> I <br /> FILE,�1DI7RESS L EN L�3 ' <br /> Oa CGll�vrn <br /> '3 s-" c P, 3 <br /> it <br /> !i <br /> it <br /> TI11S rl0"110E IS SUBJECT 1.0 1114E REQUIREMENTS IDENTIFIED IN THE PUBLIC )J ,ALT14 <br /> SERV(CCSIENVIRONMCNTALHEALTH DIVISION (EHD)POLICY X94-007, ORDINANCECODE;�P SAN <br /> )OAQUIN COUNTY, EHD FEES AND SERVICE CHARGE RESOLUTJONS, STATE WATL•RI CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> j. A MAXIMUM OF TEN (11) PREM15I1 ADDRESSES PER RrQU&ST. <br /> 'I <br /> ij <br /> 2. PUBUc FILES/RECORDS REVIEW is aY APPOINTMEKr ONLY. AppojwvrNTS AAH ARRAr ow aY <br /> CALLING (209)468-0340. OF ICS 110UR9 FOR APrOINTM&NTS ARE. SCIIEDULED MONDAY TIIRUIIFRIDAY <br /> EXCLUDING HOLIDAYS, 8:00 AM TO 12:40 NOON AND 1:00 PM TQ 4:30 PM. <br /> 7. A 1'UB:LIc REcoew RELBAn Aprucxt:ON (PRRA) to RsQucRev. i <br /> ii <br /> 4. PUBLIC FILES/RECORDS Nor RETURNED IN Tur.SAmia CONDITION A9 RECEIVED WILL BE CCAREC—MD <br /> BY T11E EHD STAFF AT T116 9XPENSfi OF TNR APPLICANT. THL9 ADDITIONAL SURVICE WILL BE BILLrsroo -118 <br /> APTUCAM'FOR PAYMENT. (SEH EHD POLICY 94-007) <br /> �i <br /> U <br /> 5. ORIGINAL PUBLIC I'IL.FJ/RECORDS 511ALL NOT BE REMOVED FROM Tm EHD PR6.'411sG3- <br /> SIGNATURE OF APPLICANT �lC� DATE <br /> li <br /> SIGNATURE OP REL13ASING OFMCIAL DATE i <br /> No PHS(EHD RECGRDS/f ILS ARE IDENTimism <br /> PIIS/EHD RECORDS/FILES EXIT ON TIM ADDRES (ES) NOTED. You WILL BE NoT1F rm W11FN <br /> RECORDS/FILES ARA AVAILA" FOR REVIEW-. <br /> n— CA-D•�.c _ <br />