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• � „�.• v r.f.s :V��l��$ UEi21 KLEINFELUER INC -.yam <br /> PHS/EHD z VU 1 <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT a PHONE NO-14'W-/fV <br /> ADDRESS <br /> AGENCY NAME PHONE NO <br /> AC DRESS <br /> FCLL ADDRESS BB�INESS NAME/ RROGRAM OR <br /> FACILIT]C TYPE OF FILE <br /> _1:C'n t=_ 4.psz.csrr.,._i,c- �jQi'F.1..>�� •�' <br /> TFiiS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIER IN THE PUBLIC HEALTH <br /> SER VICES/ENVIRON MENTAL HEALTH DIVISION ItHD1 POLICY 1194-007, ORDINANCE CODE OF <br /> S1.N JOAOUIN COUNTY, EHD FEE AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1_ A MAXIMUM OF TEN u PREMISE ADDRESSES PER REQUEST <br /> 2. PUBLIC FILESIRECORDS REVIEW IS BY APPOINTMENT ONLY. APPOINTMENTS ARE PROCESS- <br /> E[� BY CALLING 12093468-3420. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED MONDAY <br /> TI IRU FRIDAY EXCLUDING HOLIDAYS, 8:00 AM TO 12:00 NOON AND 1:00 TO 4:30 PM. <br /> 3. A PUBLIC FILESIRECORDS RELEASE APPLICATION (PRRA) IS REQUIRED. <br /> 4. PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SI AVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. (SEE EHD POLICY 94. 0071 <br /> 5 ORIGINAL PUBLIC FILESIRECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> • .••s�•.••••••:...�.• •• •��.•.•f•••►*••••.rt+a:•a•rr�•••rr•�•••�aarr.••• <br /> S GNATURE OF APPLICA DATE/d/�!z/ g <br /> S+GNATURE OF RELEASING OFFICIAL [SATE; <br /> E 100 14 (REV 9196) <br />