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�.✓ 4s <br /> aLL <br /> T©_d -ulClt <br /> SAN JOAQUIN COUN'T'Y <br /> PL7HLZC H»Ai,TH SERVICES <br /> 2MVIRONMENTAL HIRALTH DIVISION <br /> I , ` PUBLiTC RSCORDS 1; ELECASE APPLICATION <br /> APPLICANT ►r n --_ PHONB�NO <br /> ,ADDRESS 40 O <br /> AGENCY NAM '1C —n QY — <br /> ADDRESS '5 �•-•___� � <br /> Yi#'k*k*#*'k![*�•�***'�'�"7k*'k'Yft**'�f4*tk•k•k'+ft'�'tMit*'**'k#it***'k#'*-t'k****w*#�f it* t�fw <br /> U7NES nRc OR <br /> FULL $L?�� NA TYP6 QF �7 <br /> FACS _Zi�`7'T*Y ��•-"`" <br /> 2 25 u,n i r� C. -5 1tt�, `7 - F I.e vt v, '�5: - �.cf►�;�fiS a�' <br /> ,ra <br /> Ulf <br /> loqcr <br /> QSfi <br /> S3 � yore +-/ <br /> t*it��**�tw*�*two-t*-��•,�,��w*�w.�,k�,►*,�** ,r�t�k..# <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUDLIC HEALTH <br /> SERVICESIENVIRONMENTAI^ HEALTH DIVISION (EHDI POLICY #94-1107, ORDINANCE CODE OF <br /> SAN JOAQUIN COUNTY. EHD FEE AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1. A MAXIMUM OF Iga 11102 T-REMISE ADDRESSES PER REQUEST <br /> Z. PUBLIC FILESIRECORDS REVIEW IS BY 6ppoINTMENT ONLY APPOINTMENTS AmE PROCESS- <br /> ED BY CALLING 1209)468.3420, OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED MONDAY <br /> THRU FRIDAY EXCLUDING HOLIDAYS, 5:00 AM TO 12:00 NOON AND 1:00 TO 4:80 PM_ <br /> 3. A PUBLIC FILESIRECORDS RELEASE APPLICATION (PRRA) IS REQUIRD. <br /> 4. PUBLIC FILESIRECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL. BE <br /> CORRECTFb BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL EM BILLED TO THE APPLICANT FOR PAYMENT. (SEE EHO POLICY 94.007) <br /> S. ORIGINAL PUBLIC FILESIRECORDS SHALL NOT BE REMOVED FROMTHE EHO PREMISES_ <br /> •i••Y r.�•f••f!t}•r1Fri•�� 4P •ta +t • •ii•+ff ff yff•!1lff r?i •• •••f•if• <br /> SIGNATURE OF APPLIC t DATE � t� <br /> SIGNATURE OF RELEASING 0 CIAL DATE <br /> EH 00 14 (RI~V 9198) <br />