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iC <br /> SAN JOAQUIN COUNTY S I'SI <br /> PUBLIC HEALTH SERVICES - . <br /> ENVIItONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE REQUEST FORM <br /> INDIVIDUAL <br /> NAME as 7 `/a 1 C_(r PHONE NO )S9.L <br /> ADDRESS .LZp 'p FZ S�'2 �( ii: <br /> AGENCY NAME C� ' <br /> Co PHONE O S arZ <br /> ADDRESS . <br /> FILE ADDRESS EAD ENFORCEMENT DATE OF <br /> AGENCY REQUEST <br /> -- <br /> z7Z � . -,,boc'ado S \,)Jock) ae ..iH 4� <br /> ` ttL rr 3Sz7 <br /> 7 L crr, co z D : Sys�7 L� <br /> S 4-4 �ff t 116 577 <br /> I,, 1 <br /> ;r <br /> T. <br /> r< <br /> San Joaquin County Public Health Services Environmental Health Division files are co!"; red public records <br /> except for certain documents identilYed�in the Government Code and the State Watei'iCode_ <br /> Requessts for public records or file reviews are subject to charges established in San Joaquin County Rules and <br /> Regulation Environmental Health Permit Fees and Services Charges. <br /> Charges for records or documents requested by subpoena duces tecum are subject to changes established in <br /> the Evidence Code. <br /> Photo copies of public documents are subject to Public Records Policy:#91-001. <br /> SIGNATURE OF REQUESTING PARTY i DATE 'Z�S <br /> SIGNATURE OF RELEASING OFFICIAL !>,DATE <br /> ESI 00 14 (REV 3/91) , <br />