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SAN JOAQUIN COUNTY LJ <br /> PUBLIC HEALTH SERVICES rAtUtJ=fl 55—Z.O b <br /> ENVIRONMENTAL HEALTH DMSION <br /> PUBLIC RECORDS RELEASE REQUEST FORM <br /> INDIVIDUAL NAME <br /> _ _ PHONENO g6r1- 1)r7 <br /> ADDRESS , �� �� t)Jl n 9 r t f S a 6 1 !f <br /> AGENCY NAME t�,_�;�� _;;��� - e PHONE NU <br /> ADDRESS <br /> FILE ADDRESS LEAD ENFORCEMENT DATE OF <br /> AGENCY REQUEST <br /> � 777 <br /> �'� t l� E..!).1.���, s•�.f y"`y� ^,i; 3-- L fI L �,S,oZ l ,f r !rr <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 Feels 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-Mi. <br /> SIGNATURE OF REQUESTING PARTY L" o DATE 101 . 1-9., <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 3/91) <br />