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SAN JOAQUIN COUNTY �ys-SSI <br /> PUBLIC HEAL'T'H SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION 3 Y <br /> PUBLIC RECORDS RELEASE REQUEST FORM <br /> INDIVIDUAL NAME —FV\n rr\cxc, -T `/cA t L� PHONE NO_L `-2,)59.L <br /> ADDRESS S-�-.e L1(9 <br /> AGENCY NAME 'u Co PHONE NO SaYy.� ' <br /> ADDRESS , <br /> FILE ADDRESS Qcl� Hl `� LEAD ENFORCEMENT DATE OF <br /> AGENCY REQUEST <br /> S�- C\J_4ZvJC�C_C�' Si 4�� <br /> 351-7 <br /> or LOP; 5i COAo - Z&n A- �' 35�7 <br /> L;� l n S fi CU R� t u' _� S"i IP c o c) '9 �. <br /> s r �� �. <br /> �� ff �J \I -��� C F 1-�,�c .IS,.,��e �.: 1.L63�I5�� rf <br /> an <br /> 5y �j , � <br /> +� 357 <br /> nwo I�4 �, CrYQo '. �� 1 �r x,,4 0 <br /> I <br /> San Joaquin County Public Health Services Environmental Health Division files are considered public records <br /> except for certain documents identified in the Government Code and the State Water Code. <br /> Requests for public records or file reviews are subject to charges established in San Joaquin County Rules and <br /> Regulation Environmental Health Permit Fees and Services Charges. <br /> Charges for records or documents requested by subpoena duces tecum are subject to changes established in <br /> the Evidence Code. <br /> Photo copies of public documents are subject to Public Records Policy #91-001. <br /> SIGNATURE OF REQUESTING PARTY DATE e�z-9S <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> T <br /> EH 00 14 (REV 3/91) <br />