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SAN JOAQUIN COUNTY ; <br /> PUBLIC HEALTH SERVICES "y <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE REQUEST FORM <br /> INDIVIDUAL NAME --k CZPC N v I t PHONE NO(40%) o2ci-7- qCb <br /> ADDRESS Ss-r- N- st s►e too &='- � W'ost, C�ft - S//oq <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> FILE ADDRESS LEAD ENFORCEMENT DATE OF <br /> AGENCY REQUEST <br /> +D 41A aaa�Lat'm <br /> 8-2,0 -9 <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 fl `pCt7U DATE c9-o9-7-19'54=) <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 3/91) <br />