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Ell VU 14 (REV 5194) SAN ,IOAgUIN COUN'T'Y <br /> 1'UlILIC HEALTH SERV1C1F„S <br /> ENVIRONMENTAL 1JEA1311 DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APl'L[CAN"i' J-41 >0 11IIONI? NO <br /> ADDRESS <br /> AGENCY NAME �� PHONE NO <br /> ADDRESS <br /> FILL ADDRESS LEAD AGENCY DATE <br /> duiL 41 <br /> 1-7 � /Hca/'�•/!nr -tf 'r ��f f ��C r! ' l--y — �3 .� <br /> if . Sb <br /> vL)Cr L OD � Ir 4r iI l � S:�G <br /> �l <br /> THIS NO'T'ICE IS SUIJJEcr 'r0 '1'111: RI?QUIRENIENTS IDENTIFIED IN TML 1'U 13 LIC III:AI:III <br /> SI;RVICI:S/LNVIIiONMIiN'I'Ai_HEALTH DIVISION (EI ID) POLICY #94-007, ORDINANCE COI]i's Of SAN <br /> JOAQUIN COUNTY, EIID I EESAND SERVICE CIJARGL RuSOLUTIONS, S"1'A'1'I; WATER COUH, <br /> GOVERNMENT CODE AND 'ITIE EVIDENCE CODE. <br /> 1. A MAXIMUM OF •rr:N (IU) PREMI.- i Aul)Rrss" mut RI-QUEsT. <br /> 2. Punuc FII,11SMECORDS 1MME-W 1s IIY API1O1NTMLN"I'ONLY. AI•I'OIN-i-MfN-I'S ARE ARRAmor;U By <br /> CALLING (209)468 {1341). OFFIC11 1101)113 FOR APPOIRI- ENTS ARI? SC111'sDULED MONDAY TIIRU FRIDAY <br /> L.XCLUDING HOLIDAYS, 8:00 AM -ro 12.00 NOON AND 1:00 PA! •ro 4:30 rm. <br /> 1 <br /> 3. A PUBLIC RECORDS RrI.EAsE ArrucxrioN (PIMA) IS REQUIRFI). <br /> 4. Punuc FILESIRECORDS NOW Ris`I-URNFD IN -rl1E- SANiG CONDITION AS RCCGIVFD WILL 1111 CORRECHA) <br /> fly i-SIG E11D STAFF AT "rim- GXI'rNSE OF rim APPLICANT. THIS ADDfrEONAL SERVICE- WILL BE 1)ILLE.V TO TIIG <br /> APPLICAN-T FOR PAYMENT. (SCG URD POLICY 94-007) <br /> 5. ORIOINAL PUBLIC I'1LLSIRLCORDS SHALL NOT ilE- RFMOVEI) FROM THE LAID PREMISrs. <br /> SIGNATURE OF API'LACAN'C_,. DATE <br /> SIGNATURE OF RELEASING OFMCIAL DATE <br /> No 1'IIS/EI ID AtECORDs/F1LCS ARE IUE-NTIrirD: <br /> Il4/nr Rl+vtlnviln■r: IiknlrlcAn`we U�knl . <br /> i <br /> PIIS/€?FID RrcoRDS/FILES E=,xis-r ON 'rill, ADVRFSS(GS) NOTED. YOU ITILL BE NOTIFlr-D WIZEN <br /> Itrconj)s il.GS ARE AVAILAMX FOR REVIEW: <br /> IIAITRmnmmn Ar: MmrerAry a PALM <br /> k <br />