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7--1.�"1 tJ'Jb I YJ[4GxNl i KUI.1 xv v rte vt..w �.�uu•v s,tow• ...t..:: ti.t.r, , ... - -- — _ , <br /> SA14 JOAQUIN COUNTY ' <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL' HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> G:af...► r> <br /> APPLICANT ONE ONE NO04" L/b7- /cad <br /> 1 <br /> /�1�UP.ESS„ t{D.o�.1� 'i :�.4 W.1s• / S10 �n� 520'7 -- <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> t#•.i###t•r.# ..#a*,�+***##t#t*+t+a,r+#* w,rt,t*.r+c:#+tt*+**•***#*#t***+*t#t•* <br /> gam( NES_ 1VR,ME/ PRQGPAM_2 <br /> FULL , AllDRESS FACILI' TYFB OF FILE <br /> r-P IDR l�fi(1n 5iree},1l&-Issig _ <br /> -I /�)dry TFtA <br /> 17 �Io gaily �I�Q, te4 ANtc,A CR�r#rcl —Uz�ti WAc*e- <br /> mq�v <br /> $ ? S �. l LS tc _s.02 7 <br /> te+ <br /> - G nafrrtca � V_— <br /> EL S / � z <br /> 1775 Ns eAaIn Crit �m � aMa �a.,r�4i1__J <br /> #*rr+tri•k#*tfir+#+ Ari�#-tt�,t*,t�rik+#tiFk�•*lit+rikttxt•k*+�9ci,i�ri#,rt,tfkalt�t**,tr+M! <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICESIENVIRONMENTAL HEALTH DIVISION IEHDI POLICY 1194-007. ORDINANCE CODE OF <br /> SAN JOAQVIN COUNTY, EMU FEE AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE. <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1. •A MAXIMUM OF TEN WO PREMISE ADDRESSES PER REQUEST <br /> 2. PUBLIC FILESltiECOR05 REVIEW 1$ BY ApPO FOO AAPOINTMENTS A E SCHEDULED MONDAY <br /> NTMENT ONLY. APPOINTMENTS ARE PROCESS <br /> ED BY CALLING 1209!468-3420- OFFICE HOURS <br /> TI4RU FRIDAY EXCLUDING HOLIDAYS, 8:00 AM•TO 12:00 NOON AND 1:00 TO 4:30 PM: <br /> 3. A PUBLIC FILES/RECORDS RELEASE APPWATION IPRRAI IS REOUIRED- <br /> 4. PUBLIC FILESIRECORDS NOT RETURNED�IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED L THE LED TO THE APPLICANT FOR PAYMEND STAFF AT THE EXPENSE OF THE T. (SEE END POLICY 94PLICANT. THIS ' 007)' <br /> AL <br /> SERVICE WILL BE <br /> 5. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE EHO PREMISES. <br /> •1•...f f i •...4.. <br /> ;44*....f 40.040. <br /> ♦.i• <br /> • ,�. ....... DATE <br /> ..... ................... . . <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> SIGNATURE OF RELEASING OFFICIAL <br /> EH 00 14 (REV 91961 <br />