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r i <br /> cz/ <br /> SAN JOAQUIN COUNTY <br /> - PUBLIC HEALTH SERVICES <br /> i ENVIRONMENTAL, HEALTH DIVI!410N <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> i <br /> ' APL,tL-ANT & PHONE i NO 'fir S 3'71 - Z Sj o c7 <br /> ADF)Ikrsg []ill/11P51 �..Ny,r[: S.t{4a'- x..1..1 ` . I Sc �:LA G' S^•� .n1. �.{ /4�r'4f <br /> A[RiIC,�i 14AME .. - PHONE 10 _.,. <br /> ADDRESS i <br /> - + itttit+#tttta#rtr##,t#*�#+r##+ tt#tf###a*t** kt�#tt��Fttk*t•�t##,t#,t*t**t <br /> I <br /> FI.ILL AADRESS BUSINESS-_Nj ME1 i G 0 i <br /> IE l I I FACILITY_ E FILE <br /> t 7r5S 4v• rinr.r, a• L,•.� �l0( A! t'+•. 1lw �,r5 f':�r.S. ".j i <br /> ! 1 -71(2 L_ W r-rL._�z• La,,c ` toc tC �l f'.r Kw rS L IZ+.•�rg } <br /> Liv) 5rvi iilu. 4L Kka r'l <br /> t tZ arn+ Frr•„,. Lnne S��C�tr�„ t1� « _ ��5 .2-(, (fKl <br /> 1 IN e: +GY pr\..t1_09� L S re i C Fu, 135 <br /> II <br /> �� + tt�tt##t##it#####t#'#ttttt#####f# !•t#t#tt*+�"ktY�rt#:**##�' k#######*## <br /> THIS NOTICE IS SUBJECT TO THE REOUIREMENTS IDENTIFIED 1THE PUBLIC HEALTH Y <br /> S*VICES/ENVIRONMENTAL HEALTH DIVISION IEHDI POLICY 09 -007, ORDINANCE CODE OF <br /> S4N 'JpAOUIN COUNTY, EHD PEE ANE) SERVICE CHARGE RESOL�TIONS, STATE WATEFI CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> + <br /> 1_ A.M�WMUM OF TEN 11JO PREMISE ADDRESSES PER REQUEST <br /> 2.i PUB IC FILESIRECORDS REVIEW IS BY APPOINTMENT ONLY, APPOINTMENTS ARE PROCESS- <br /> ; Eft BY CALLING (2091468-3420. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED MONDAY <br /> THRU F�IDAY EXCLUDING HOLIDAY$, 8:00 AM TO 12:00 NOON,AND 1:00 TO 4:30 PM. <br /> 3.i A'P4�lBLIC FILES/RECORDS RELEASE APPLICATION (PRRA1 IS REQUIRED. <br /> d.� f OB!_IC FILESgECORDS NOT RETURNED 1N THE SAME CONDITION AS RECEIVED WILL BE <br /> CORREC:L'D 13Y THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> S VICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. 1SeE EHD POLICY 94- 007) <br /> r <br /> i <br /> 5.i ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> 1 <br /> i •. : •.............. •.. ....�...aa•a aaas.•a•....s�..s�..•sa��a�a��a t��as•r• <br /> SIGNTURF OF APPLICANT DATE r 7'i <br /> SIGN TURE OF RELEASING OFFICIAL DINE <br /> EH 0 14 (REV 9/961 <br /> TOTAL P.01 <br />