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MOUM,CA V3336 Fax, 1569-0295 <br /> �-GEe �c.•ttc..• ✓ <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES i <br /> ENVIRONMENTAL [31;AI,TH DIVXS T nN <br /> PUBLIC RECORDS RELEASE APPLICATION � <br /> PHONE NO <br /> APPLICANT wic V <br /> ADDRESS 2`i 37 ti/. (t ��MJ Pn �•Ia o S ------ Gs Sa 4 <br /> AGENCY NAME S� <br /> PHONE NO ?rc+�i <br /> ADORSSS -. — <br /> ry***# *{, ♦ • 4- 4- <br /> rY'r#*•r i +i't****### t i ♦ a 1#*'R"1"k**# i i ♦ a R r*#tt•tt#i A ♦ R A A • R i <br /> �f�l'T NLSS NAME! �c?r�C'It�1M OR <br /> FULL DBi� RESa FA TT,T'lY �L� TYPE 9F F]:X:C <br /> 17 <br /> .L,-A �I t�I1 til � �2.%fir • S 1 lr�r•.1tL�-..A i i J-�' .. <br /> # *# #/( rttlr*'!r•*++ 4'*'k***#+#+ i a a a w'xR"R'ir'R"�'#'t#### A k r a ► k'k'A•# k# * * +h <br /> THIS NOTICE IS SUBJECT T'U i HE REQUIREMENTS IDENTIFIED IN THE PVBLIC HEAL1 I I <br /> 07, <br /> SERVICE SIENVIRONMENTAL HEALTH DfCE CODE OF <br /> V1510N (EH RRG�IRE50LUTCY OIONS, STATE ORDINA ,WATER COBE:, <br /> SAN JOAQUIN COUNTY, EHO FEE AND SERVICE CW <br /> GOVERNMENT CODE AND THE EVIDENCE CGDE. <br /> 1. A MAXIMUM OF TEN L1 PREMISE ADDRESSES PER REQUEST <br /> Z. PUBLIC FILES/RECORDS REVIEW IS BY APPOItVTMENY ONLY. APPOINTMEN-I S AIiL NItOCESS <br /> EO BY CALLING 12091468-3420. OFFICE 8.00 AM TOR 2:QO NOON ANDAPPOINTMENTS1 00 TO 4RE D30 pMMONDAY <br /> THRU FRIDAY EXCLUDING HOLIDAYS <br /> 3. A PUBLIC FILESJRECORDS RELEASE APPLICATION JPRRAI IS REQUIRED. <br /> a. PUBLIC FILE51Ii�COIiUS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL 6E <br /> CORRECTED BY THE EHD STAFF AT <br /> THE ANT FOR PAYMENEXPENSE OF THE T. PLICANT, THIS AL <br /> SEE EHO POLICY 94- 007 <br /> SERVICE WILL BE BILLED TO THE <br /> g. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE EHD ('REMISES. <br /> .•••• .... ..... <br /> r ♦ ♦ • <br /> .. . . . ......w•.a .... .. ♦♦•. • w• ••. ►a • ........•........•. <br /> Vim,.<� L: ^ -+�t DATEG r7 ��_. ... .... . <br /> SIGNATURE OF APF LICAN'i Pc.-• <br />