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SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT <'' / (% (J PHONE NO <br /> ADDRESS �'��' �-�' ,�,;;(� _•.. �' ;-f� -v <br /> AG ENCY NAME 11 ZnE '5;/lb,6, d PHONE NO -i - <br /> ADDRESS <br /> FULL ADDRESS BUSINESS NAME/ PROGRAM OR <br /> FACILITY TYPE OF FILE <br /> �/�_•/ - �.��.Z.;i, 1 ,ice �-y.�',�.' � �,�� L�/N' T It s2'\ �� �� �r�),�i S �� �i/ <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC 14EALTH <br /> DIVISION IEHD) POLICY #94-007, ORDINANCE CODE OF <br /> P.O.Box 643 P_O.Box 623 ID SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> Modesto,CA 95353 Stockton,CA 95201 :NCE CODE. <br /> .E ADDRESSES PER REQUEST <br /> ROBERT B. SMOKE <br /> m is S BY APPOINTMENT ONLY. APPOINTMENTS ARE PROCESS- <br /> Adjusting& investigative Services ICE HOURS FOR APPOINTMENTS ARE SCHEDULED MONDAY <br /> i, 8:00 AM TO 12:00 NOON AND 1:00 TO 4:30,PM. <br /> Office(209)522-9250 Office 209-547-9250 SE APPLICATION (PRRAI IS REQUIRED. <br /> Fax(209)547-9252 Fax 209-547-9252 <br /> 4. PUBLIC FILES/REC;UMUS tvv I Kr-i URNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. (SEE EHD POLICY 94- 007) <br /> 5. ORIGINAL PUBLIC FILESIRECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> DATE <br /> SIGNATURE OF APPLICANT �tti�%r <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 9/96) <br />