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�.r SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICESLt <br /> �1 � <br /> E1WIItONMENTAL HEALTH DIVISION <br /> 'A. <br /> PUBLIC RECORDS RELEASE REQUEST FORM <br /> 5-/ o -- L/(0-36OO <br /> 1 <br /> INDIVIDUAL NAME( i �iPHONE NO 5-/4 Z Zf7ff�5� <br /> a ADDRESS <Z3LV <br /> AGENCY NAME P14ONE NO <br /> ADDRESS <br /> FILE ADDRESS LEAD ENFORCEMENT DATE OF <br /> r AGENCY REQUEST <br /> ,3Sall <br /> h <br /> r <br /> -w T —2 0 1995 <br /> ENVIRON M H <br /> RM <br /> San Joaquin County Public Health Services Environmental Health Division riles are considered public records <br /> except for certain documents identified in the Government Code and the State Water Code. <br /> Requests for public records or fele reviews are subject to charges established in San Joaquin County Rules and <br /> Regulation Environmental Health Permit Fees and Services Charges. <br /> Charges for records or documents requested by subpoena duces tecurn are subject to changes established in <br /> the Evidence Code. <br /> Photo copies of public documents are subject to Public Records Policy #91.001. <br /> SIGNATURE OF REQUESTING PARTY DATE Z!L <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 3191) <br />