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Nwwl <br /> 9g - 09& <br /> SAN JOP_QUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION CO " "T <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT Q� i - PHONE NO � iCn� rc� _CDU <br /> C�rcl <br /> ADDRESS f2 PJIONE NO <br /> AGENCY NAME 1"v 'l -- <br /> ADDRESS <br /> BUSINESS NAME PROGRAM OR <br /> 1:ULL ADDRESS FACILITY TYPE OF FILE <br /> '101 0.rn ',!Sbto Ic 1 nr� [)- H � — `� c ��`l <br /> ZA O t <br /> THIS NOTICE IS SUBJONME ENTAOHEALTH DIVISION {EHD) POLICY #94 007HE REQUIREMENTS IDENTIFIED IN THE , <br /> SERVICES/ENVIRONORD UBLIC NANCE CODE OF <br /> SAN JOAQUIN COUNTY, EHD CODE, <br /> 1 . <br /> CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THEEVIDENCE <br /> 1 . A MAXIMUM OF TEN t10I PREMISE ADDRESSES PER REQUEST <br /> 2. BY CA ING (RECO66- REVIEW <br /> 201 OFF CE HOURS IS BY NTMENT—ONLY.FOR OR APPOINTMENT DARE SCHEDULED MONDAY <br /> INTMENTS ARE PROCESS- <br /> ED BY GALLING (2091468 3 <br /> THRU FRIDAY EXCLUDING HOLIDAYS, 6:00 AM TO 12:00 NOON AND 1:00 TO 4:30 PM. <br /> 3. A PUBLIC FILES/RECORDS RELEASE APPLICATION {PRRA) IS REQUIRED. <br /> 4. PUBLIC FILES/RECORDS NOT RETURNED MHESAE CAGPPo1CAGNTA THIS ADD T ONAL RECEIVED WILL E <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. (SEE END POLICY 94- 007) <br /> 5. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> ... ... . • .!.-f w. ...•....a w w...w <br /> .www...... <br /> ..... ...... .. . ........ . ... DATE -� <br /> SIGNATURE OF APPLICANT <br /> SIGNATURE OF RELEASING OFFICIAL <br /> DATE <br /> EH 00 14 (REV 9/96) <br />