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APR-20-98 13:05 From: Tetra T an Francisco 4159745914 T-595 P.02/02 Job-63T <br /> j <br /> 1/v - 017 7 <br /> SAN JOAQUIN COONNPY <br /> PUSLIC HEALTH SERVICES <br /> j ENVTlZ0NMENTAL HRALT14 02VIS ION <br /> j PUBLIC RECORDS RELEASE APPLICATION <br /> AP4ICANT_M�c) 1. 2�Wt a. NO 4 <br /> ADD ESS�1 �j wiz rSr 2- SL�Sea �Csn►ntisc.o gtilfe5 C�rur <br /> AGE C NAME ` ' ��-��.�� PIiONE NO tv�,.,,f <br /> ADD 13SS "7"'�"'e° <br /> i <br /> vri ir{•y1•t 1tY#*#*t*Y#Yll'*2tf#Ywt#*#it#ittt+t#tt#*t##**#Y i #*#t*f#*•##*i.f.k <br /> FULL AQUgESS 1 AUSINES9_NAMEL n OR <br /> TpE OF FTT,p <br /> dK 1D 1 n P"a. to �ww1 S►A t�, Ga�.�d.t' 6+r U sT� <br /> { <br /> I <br /> i <br /> *+rfiw**tww##twt#w##t+tt##tf rasrw,r+t#ttt+t++,t**r*tttt*er-..r**w,t.fry.,r <br /> THIS OTICE 1S SUBJECT TO THE REaU1REMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERV _ES/ENVIRO1yMEN TAL HEALTH DIVISION IFNI)) POLICY #94-007, ORDINANCE CQOE OF <br /> SAN 7?OAQUIN COUNTY, END FEE AND SERVICE CHARG!c RESOLUTIONS, STATE WATER CODE. <br /> GOVESNMENT CODE AND THE EVIDENCE CODE_ <br /> I- Al MAXIMUM OF TEN ilei PREMISE ADDRESSES PER REQUEST <br /> 1 <br /> 2. PUBLJC FILES/RECORDS. REVIEW IS 8Y AP�MENT ONLY. APPOINTMENTS ARE PROCESS- <br /> ED B� CALLING 1209)468-3420. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED MONDAY <br /> THR FRIDAY EXCLUDING HOLIDAYS, 8:00 AM TO 12:00 NOON AND 1:00 TO 4:30 PMt. <br /> 3. A(PUBLIC FILESIRECORDS RELEASE APPLICATION IPRRA) IS REQUIRED. <br /> 4. PUBLIC PILES/RECORDS NOT RETUfiNF-D IN THE SAME CONDITION AS RECEIVED WILL BE <br /> COR14ECTEO 9Y THE EHO STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL SE BILLED TO THE APPLICANT FOR PAYMENT. (SEE EHD POLICY 94- 0071 <br /> 5. QI%IGINAL PUBLIC FILESIRECORDS SHALL NOT BE REMOVED FROM THE EMD PREMISES. <br /> r.�ar r��r r r r•.a.►r r•r r ♦a ♦t• •�r r r r♦.r._•.r i t r��•r..............r.r•rrt.rsrrr <br /> SIGN Al' Y'UFIE OF APPLICANT r �vv�at DATE uN . <br /> I <br /> SIGNATURE OF RELEASING OFFICIAL OATS <br /> EH 0,014.1REV 9/96) <br />