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I=Rf_rf1 - FaF�Fi Fin+:e rnnrnen t�] � PHr_iFJE 1,10. r_0 369 -1229 Frog. 19 1999__ 1.1 <br /> 5,I1N JO11C)UT[d COiTN'1'1' <br /> c{ �� <br /> PUBLIC HEAT,TI? SRRVICRS <br /> ENVIRONMENTAL 112 .1 H DIVISTON <br /> PUBLIC RECrJRLDS RICLEASE APPLICATION <br /> PRONR NO <br /> ADDRESS <br /> AGENCY Nl1MB � Iv10 <br /> E; <br /> ADDPESS_-Z2�_-_ , <br /> 4k <br /> $iJS INE NAMS1 PRO RAM-0 <br /> f-ULL ADDR.EIS-S2LYpF___i1F > .ILE <br /> •klrtit�itirk**dY-rl"kiF�*-kt A klr**ale##it t##i A ##1k�rir**ik*er#"*itit�-k#:k*kvkiril4 ,ttF*i **# k <br /> 'TH15 1`40T10E IS SULIJECT TO THE naGUIREMFNTS IDENTIFIED IN THIE PUBLIC HF-ALTH <br /> SERVIGESIFrIvIROrlM1 INIAL HEALTH DIVISION {E 17) POt.ICY 094-007, ORDINANCE CODE OF <br /> SAN JOAOUIN COUNTY, EHD FEE AND SERVICE C�ARCF 1iESOLUTIQIVS, STATE WATER CODE, <br /> GOVEr3NMI"NT CODE AND THE EVIDENCE CORE. <br /> 1. A MAXIMUM OF 1F_I11 LLQJ PREMISE ADDRESSES PER REQUEST <br /> 2. PUBLIC FIL.ESIRECORRS REVIEW IS BY APP4- —FOR <br /> T INTENT D111LY. APPOINTMENTS ARE PROCESS- <br /> ED BY GALLING 1209)4(38^3420. OFFICE HDQRS FOR APPOINTMENTS ARE SCHEDULED MONDAY <br /> THRU FRIDAY EXCLUDING HOLIDAYS, 8:00 AM T6 <br /> 12:00 NOON AND 1'40 TO 4:30 PM. <br /> 3. A PUBLIC FILESIFIECORDS RELEASE APPLICATION (PARA) IS REWIRED- <br /> 4. PUBLIC FILESIRECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WELL OF- <br /> CORRECTED <br /> ECORRECTED BY TI IE EHD STAFF AT THE EXPENSE 01= THE APPLICANT. THIS AD011-10NAL <br /> SERVICE WILL 8F BILLED TO THE APPLICANT FOR PAYMFNT. [SEE EHL? POLICY 94- 407? <br /> S. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE CI-ID PREMISES. <br /> ..a a .•.a a a•► ...: r a s. • .^. ...ars a s..•Y e r s saw.*a. ... ♦.s.a f a•.a. a• <br /> SIGNATURE OF APPLICANT r__ <br /> DATE <br /> SIGNATUIIF OF RELEASING OFFICIAL_ __ DATE <br /> Ell 00 14 (REV 9196) <br />