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F7- f-73 <br /> -r <br /> SAN JOAQUIN COUNTY <br /> PUBLIC 11r.A.LT11 SERVICES <br /> ENVIRC MEWrAL ETEALT1i DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> nPPU.iC:hrrt' LG�c_. 4 [' <br /> tY _ P11(]1VS PJU _�Jf��Y - a'tX:2 <br /> C-4 - <br /> AC FINC rci.�rlr f.7— L_ CJ,r�IL3 fle_ PHONE NO <br /> ADORCSS <br /> * t ► r+•rxx#* r **** Ak k J<•Ir***xtk** A- k•k-h*t 0- A, 1,# ,F4•+!• ►ii #• s •-k kkA#x•rxt#**++� <br /> F.-UL,L AUllR $a. BU Sl NIRS2 NAME1 PR!?GRAM OR <br /> Ft�C ILl'L'Y 'TYPE OF FILL <br /> 14"43 tVaH. iiG� ck1�1 Y YDl7 1-kA 4fAlifwt­I(ic <br /> -Lgq0 IVAIL4�L <br /> J.t11..Ala t_'- „Q—t f-0- �t y!' oee.s��%,� jss5/1 f1- <br /> 5. �,�[ � �' '°✓' n SSS�-�• nt Z1d � +L'lzfo� <br /> 1 3 S'-w�Lel S 1` <br /> 1• a)rt- tam ++ �l¢Ys_.t e ucsr -- -- <br /> 1_al��� eJe_ NPL -- <br /> 1jv Alit W14 R6 j� �r�I._CQr! ie <br /> A, ♦i, f, r*►+#kxxtxt#k k##♦ k k k r k k k k t* k kat#*#ir krF¢#•w*tt<#* k,4•k•kixt+t#### <br /> I'hltS NO)'ICF IS 5U8.IFCT TO THE R1701311TEMUNT S ILTNTnED IN THr= PUBLIC HEALTH <br /> SERVICFS/ENVIRONNIENTAL IWALTH DIVISION (FHDI POLICY #94-007, ORDINANCE CODE OF <br /> SAP•I .1C)A(_AJIfd COUNTY, Ft I0 FI E; AND SFRVIC!` CHAnGE RESOL(lF{ONS. STATER ('ODE. <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1 . A rAAXMAI3M OF eEN (:l0! PREMISF AI)(IT E9S' ES PER RF_(1UE5I <br /> Z. PURLIC FTI_F511TFCf)R1)5 f;t�!}F_1N IS RY APPS3_IN7_m- T 0 ILY. APF NNTMENTS ARE PROCESS- <br /> FI) RY !'AI I Ihl(; 170'I1d(;li ;3220 QFFICF 1-IflWAS FOR APPOINTMENTS ARE SCHFDtJt ET) MONDAY <br /> 7'HR13 FRIDAY FXCLUDINGs HOLIDAYS. B-4-10 AM TO 12:00 NOON AND 1:00 TO 4:30 PM. <br /> 3. A PURI.W.' FII_f`TIRFf:nF1U4 RF_►_FASU APPLICATION (PRRA1 IS REQUInED. <br /> ,i. PU►;1_ft” FILESiRF.! !?f;l7S NOT RET'lWNED IN Ii It- $AMI= CONDITION AS RECF_IVI_D Will BG <br /> (:(_)RHFC;TE1.7 RY THE EMD S 1-AFF= AT THE FXPFIIISF nF TI•IF A1'1'l.lr'AN I 11111; ADDITTONAt_ <br /> SERVICE N111.1_ ETF Bit-LFI) [U I[IF, APPLICAMr FOR PAYMENT (SFE FHD POLICY 94 007) <br /> ` '11EC!?t2F)S EOVECMri;[ Clb PREYSS.SHALL fII)T F3F PtIS. [ tlGINn _ PUZLiC `1lG <br /> . . . . . . . . . . . . .. .. .. . .. . ... .. . .... . . ...../. . .. . ... .... ... ........ ............. <br /> SIGMA IUHr: OF APPI_ICANT ( DATE <br /> SIGNATURE OF RFI FA SING OFFICIAL_ DATE <br /> I+I 00 14 (REV 3i961 <br />