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I'IY-11-1=-177Q 1G•J`i 1' v. ur.. u-,v..�... ...... _ __._ _ ._ _ __ _ <br /> PUBLIC IIEA1,11I SERVICES <br /> \ (� ENVIRONMENTAL IIF.r1 ni nIVIS.JcY �— <br /> "L PUBLIC ItECORDS RELEASE APPLICATION <br /> APPLicAN r A- :Zu.i.1, PHONE NO Lt •3 <br /> ADDRESS t l zylc.A- kah S f-., t �'c' <br /> AGENCY NAME PHONE NO <br /> ADDRF$S <br /> EIS_ E ARDEM LAD AUEi`s'U DAT <br /> LA.7 �4P ICKS(I°,!4-� <br /> _ fJ�� � 1'�•ue� � A�� . S <br /> loci] <br /> THIS NotjCE IS SUBJECT TO 1T{ir REQUlltF-&f=NTS IDE N-11F'IED_IN THE PUBLIC HEALTH <br /> SF�tVICSWE"RONMENTAL HEALTH.DIVISION(EHE))POLICY#94.007,ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EHD FEES AND 5E•RYICS CHARGfi RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVWF.NCB CODS. <br /> 1. A MAXIMUM OF TEN(10)f ENIS13 ADDRMSS:PER RF,QUSIT. <br /> 2. PtIBLIC FILESIRECORDS REVIEW Is sY APPOINTMENT ONLY. Amitf MENTS ARS ARRANCFD BY <br /> CALLING (209)469-OW. OFFICE HOURS FOR APPOINTMENTS AA8 SCIIE0vLEo N[ONoi1Y TIIRU FRIDAY <br /> ECCLUDIt4G HOLIDAYS,3:00 AM 1-U 12:00 N0014 AND [:00 PM TO 4:30 PM. <br /> 3. A IlunLIC RFcoam RKLEASs APPLICATION (PRRA)IS REQUIRED. <br /> 4. Puauc FILESIRECORDS Nor XMRNED IN 7H6 sA1.11; cOND(TIO" As RrcE►va.o WILL Se CORRECTED <br /> 9Y TFiB E iD sTAFP AT THE 5XPrWS8 OF THH APPLICANT. THIS ADDITIONAL SFAV1CS WILL 98 13LLLED-TO THE <br /> APPLICANT IFOR PATbIENT. (SSE END POLICY 94.007 <br /> S. ORIGINAL PUBLIC FILF.STRECORDS SHALL NOT E8 REMOVED PRO14'TX33 EHD 1'RF"SES. <br /> SIGNATURE OF APPLICANT TY DATfi 1 n Ir�}+` b Q <br /> SIQNATU EOP RELEASING OFPICI DATE <br /> No PHS/lEHD Ri:coRbs/FIL>`s ARE lVFXTLFU5D: <br /> 1114SIEND RECORDSIFILES EXIST ON THE ADURESs(F3j NOTED. S�QU�t7LL Be NOTIFIER WHEN <br /> RECORDS/FILES ARE AVAILABLE FOR RSSI);YV: <br /> TOTAL P.O2. <br />