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10-31-19.36 01:22PN +cm TO 1916$731 22 P.02 <br /> EHyyF,r,; =liai i A.L HEALTH <br /> 96:OCT 31 PM 4' 1L <br /> SAN JOAQUIN COUNTY <br /> I PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC PECORDS RELEASE APPLICATION <br /> APPLICANT VIA 60 W Azc lLXVl'fJvW"lPHONE NO 9(G f1`T <br /> ADDRr•.SS flo, 6dXccv4��c�Ch 7-70-7 — <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> i I <br /> FULL ADIJRE95 BUSINESS NAME/ R <br /> r� l FACILITYP b IL ti 3r �G <br /> tS UMIJL Avg Z.4781,04 i�B6Y0la�f hiRA(wF) of i a�sb <br /> L4Z77htLU[_fFChT/fTuP JSir,PwT <br /> ' I <br /> THIS NOTICE IS SUBJECY'TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICE$IENVIRONMENTAL HEALTH DIVISION (FHD) POLICY 994.007, ORDINANCE CO E OF <br /> SAN JOAQUIN COUNTY, EHD FEE AND SERVICE CHARGE RESOLUTIONS, SrATE:WATEF CODE, <br /> GOVERNMENT CODE AND THF EVIDENCE CODE. <br /> 1, A MAXIMUM OF TEN 10 PREMISE ADDRESSES PER REQUEST <br /> 2. PUBLIC FILES/SECORDS REVIEW IS BY APPOINTMENT ONLY, APPOINTMENTS A13E PI OCESS- <br /> ED BY CALLING 12091468-3420. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED f ONDAY ; <br /> IHSU FRIDAY EXCLUDING <br /> I HOLIDAYS, 8:00 AM TO 12:00 NOON AND 1:00 TO 4:30 PM. <br /> 3. A PUBLIC FILF-S/RECORDS RELFASE APPLICATION (PRRA) IS REQUIRED, i <br /> i I <br /> 4, PUSUC RLESMECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED,WL BE <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITION L <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. (SEE EHD POLICY 94-'007 <br /> � I I <br /> 5. ORIGINAL PUBLIC FILESIRECORDS SHALL NOT BE REMOVED FROM THE EHD PRBIMIS S. ! <br /> l�asii ............i�llfi i • 4 irii iiiiiliifii illi} ♦1-11 lsii <br /> SIGNATURE OF APPLICANT� .C�t _DATE V all 6 <br /> SIGNATURE OF RELEASIN4 OFFICIAL --DATE <br /> CH 00 14 (REV 9186) <br /> I <br /> I <br /> I <br />