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�., SAN JOAQUiN coUMT <br /> PUBLIC HEALTH Stil"CtS <br /> k"RONMENTAL JIMT11 btVlStON <br /> IMLIC HtCo"S RELVASI✓ REQUEST FORM <br /> INDIVIDUAL NAME S-tI v� (7-- � <br /> ADDRESS 14 0 (,v a o p tt I IOLNKE?O <br /> AGENCY NAME PHONE NOG <br /> ADDRESS 2�27 r5 r p -7—(6+�-7 <br /> FILE AD MESS LEAD ENEOR _1:Mt~N-r DATE-Off <br /> AoENcy REQ............................... <br /> Ell <br /> T <br /> (,w� tM ,•,r I c�- 1 i -- <br /> 1 ,153-n 01v <br /> l `153-n01v T'S . <br /> LOC w4L <br /> -�er m T—fion nub IHos 1%Y inn KF31 U&r <br /> ItBYOS. I'S41 Cfw4-t. <br /> An%C1 loY t cw t�c.r <br /> ' w <br /> ar u.i.kilnwp 2(so W. Lcca,f <br /> w4b r"' 1 17&q W, 44-icv _ VCc31pTS C <br /> TPLUL v n t R aq w Ll.�v ks� Lo c <br /> t k4 0 Aao <br /> Ik <br /> San Joaquin County public Health Setvices P-ttvitonmental HeAlth bivWon tiles ate considered public records <br /> except tot certain documents identified le the t3ovettiment Code and the State Water code. <br /> Requests tot public tecbtds of Ale tevlem Ate sub)eet to chAtges established In San Jbequitt county Rules and <br /> Regulation Pnvitotttnental Health Petetil Pees And Setvtceg Chatges. <br /> Charges for tecotds of documents tequested by subpoena duces t6cuum.ate subJect to changes established in <br /> the Evidence code. <br /> Photo copies of public documents ate sublets to Public Records Policy #91-col. <br /> SIGNATURE OF REQUES'T'ING PAR'T'Y ^DATEl Sf 41Z <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EN 00 14 (REV 3/91) <br /> qo � <br />