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SAN JOAQt N COUNTY <br />' PUBLIC HRALTf 9RItVgCESQ. <br /> RUNMRNirAL aV LTU DMSION <br /> PUBLIC RECORDS RULEASS REQUM FORM <br />� <br /> INDIVIDUAL N DRESS .. PHorE Nv <br /> AGUENCY NAME <br /> ADDRESS /3V <br /> Pd <br /> � �0" <br /> 7 .l <br /> 4946L <br /> �Y <br /> - <br /> I <br /> 1W�F <br /> ENVIRONIMENTiAL HEALTH <br /> Seta Joaquin County Pa lic Health services PAvtranmentei Health Dlvlsion files Ire considered public records <br /> except ror certain doeu epi; fdenittled in the Govetainc tt Code sad the Stitt Water tyoft <br /> Requests for public r ds or Ole reviews ate sub)tet to charges established Itt Sen Joaquin county stoles and <br /> Regulation I?avironm tai Health Permlt Ped and 5eMoft Chetges, <br /> charges for records yr oCumettb tequested by sttbpoette ducat tecttm ere subject to changes established its <br /> the Evidence Cade <br /> Photo agptts Of public ocumenl! are subject to public Rowta Polley 091fidl. <br /> SIGNA'T'URE OF R RQUFZrING pATE <br /> r <br /> SI©NATURL 4FLEASINa OFFICLAL <br /> UA713 <br /> EH UG 14 (REV 3 I) r <br /> dittal memo 7671 1#of pages ► <br /> From <br /> U\ Dapl. P+tene 61 <br /> d F r <br />