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SAN ,70AQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIIC RECORDS RELEASE APPLICATION 7 <br /> APPLICANT i� Y`�'�F o c v� PHONE NO ^� 0) 4v <br /> ADDRESS Dc <br /> AGENCY NAME v �o� Pf10NE NO <br /> ADDRESS ° 1 <br /> BU <br /> FULL ST !sal MAI"rFL PROGRAM OR <br /> FAC. i•IY PE QE FILE <br /> 22 1"It ear Jt 1v (A <br /> G Ger J ti (,.V <br /> • tt#t#t r tttt+rk+r##�e##*t#tt##+t#+xxt#s#�;**#tltye#wtt#+r##w**�rti►t+t#tk <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICESIEWRONMENTAL HEALTH DIVISION IF-HD) POLICY 094-007, ORDINANCE CODE OF <br /> SAN JOAQUIN CQVNTY, EHE) FEE AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE. <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1 . A MAXIMUM OF—TEN 11_01 PREMISE ADORESSES PER REQUEST <br /> _. PUBLIC FILES/RECOR05 REVIEW IS BY APPOINTIL►1ENT ONLY. APPOINTMENTS ARE PROCESS- <br /> ED BY CALLING 1209#468-3420- OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED MONDAY <br /> THRU FRIDAY EXCLUDING HOLIDAYS, 8:00 AM TO 12:00 NOON AND 1;00 TO 4:30 PM- <br /> 3. A PUBLIC FILES/RECORDS RELEASE APPLICATION IPRFA) IS REQUIRED- <br /> 4. PUBLIC FILESIRECOROS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHb STAFF AT THE EXPENSE OF THE APPLICANT- THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. ISEE E-IO POLICY 94- 0071 <br /> 5, ORIGINAL PUBLIC FILESIRECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> f w�f� 1-f•-��1�1�w w• ♦• ♦�a!�� s• 4♦f� r� f- f w ���7���r w��w c•�f t w�r <br /> SIGNATURE OF APPLICANT !/V '—OAT E I� ! <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 9/9$1 <br />