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SAN JOA_QUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> � PHONE NO C9�co��.oca _�oU <br /> APPLICANT LL; �l '17 c <br /> ADDRESS 12 - r <br /> NO <br /> AGENCY NAME <br /> v -zn , FY �^� PEIONE <br /> ADDRESS <br /> BUSIN_ E_ SSEAME PROGRAM OR <br /> FULL FACILITY TYPES E <br /> X701 Tam O �hnnl e✓ Stct4.' , , . �Q q G c r; `' Q <br /> ZA00 ac A fill s Trn eu lrco ' nr, �Z S <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION IEHDI POLICY 1194-007, ORDINANCE CODE OF <br /> SAN COUNTY, EHD FEE AND SERVICE CODE AND THE EVIDENCE CODE. <br /> CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT <br /> 1. A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST <br /> Y APPOINTMENT ONLY. APPOINTMENTS ARE PROCESS- <br /> 2. PUBLIC FILES/RECORDS REVIEW IS B <br /> ED By CALLINGAPPOINTMENTS RE <br /> THRU FRIDAY EXC UIDING3420.HOLIDAYS, 8:00 AM TOOFFICE HOURSR12:00 NOON AND1:00 TO 4D•.30 PMMONDAY <br /> 3. A PUBLIC FILES/RECORDS 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 /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. (SEE EHD POLICY 94- 007) <br /> 5. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> .........................••. <br /> ✓ DATE <br /> SIGNATURE OF APPLICANT (f-( / t-- <br /> DATE <br /> SIGNATURE OF RELEASING OFFICIAL <br /> EH 00 14 (REV 9196) <br />