Laserfiche WebLink
L'11 00 14 (REV 5/9A. SAN JOAQUIN COUN'�Y 1 <br /> 111 PUBLIC HEAL'T'H SERVICES <br /> ENVIRONMENTAL IIE.AL111 DIVISION <br /> C PUBLIC RECORDS RELEASE APPLICATION �iv M•,.: <br /> APPLICANT -PHONE NO 3ZK- azx:ii <br /> ADDRESS Sic/a �Ng NO_-`�?��z Oma' <br /> AGENCY NAMB 9-cf Z Un a <br /> ADDRESS Z(S w <br /> ADDS <br /> LEAD AG$ICY DA <br /> aL �. <br /> ,F '7�trr-9y <br /> y-1�i4 <br /> L C'77, <br /> 'm/� <br /> •, <br /> -r-MIS �N0nCE �IS 'SUBIECT':TOS`THG::.REQVIREMENTSy1DENTIPIED=.IN-:THE I'UBIJC',li'EALTfi9 .e.' <br /> SCRVICFSIENVSRONMENTALHEALTHD(VISION (EHO)'POUC1p94-007.ORD(NANCECODE�bFSAN, <br /> _ <br /> JOAQUfN COUNTY. END <br /> FEES 'AND SERVICE CHARCE:1tIUTiONS r51ATE WATERiCOD$jm� <br /> GOVERNMENT CODE ANDTHE EVIDENCE <br /> ^°•Y s. y� <br /> r in a <br /> i. A MAXIMUM OF TEN(10)PRBAt98 AUDRESSEs PER AEQU64f tti <br /> 2, CVSUC F1LES/RECOROS REVIEW IS UV ACCO{NTI1txNCQNLV�AIPOINTMENT9 ARH ARRAI►Oah►Y 4x <br /> CAUJNG..(209)4694Z4O. OFFICIl.ffoURs POR`.:API'OINflUaN?S <br /> ARS p6IEOULE4'MONDAY TIIRU! FRmAr,. �. t;. <br /> EXCLUDING IIWIDAYS, B'00 AM TO 12:00 NooN AN>y 100 PM ro <br /> 5 J _ t <br /> yy / .l . <br /> 3. A PUBLIC RECORDS R61.tA76 APPLICATION (PRRA) RQ�U1RED�y z <br /> 4 <br /> 4' ..:Punic ]FII -NOT RETURNED IN THH SAIVIttoNDiTION As RECEIVED WILL ER <br /> pY THBEHD 3f AFP„AT TNH 67c1'8NS TR1S MD(t1ONA1:SaAViCH WILL pH BILLE TO•MHh�Y' <br /> H"OF THEE APPUCANI*.X+ r <br /> AMNJCAM FOR PAYMENT (SEH EHD POLICY 94"00', <br /> w <br /> . $ J ORIGINAL PUBLIC FI1.65/REGOADS SHALL NoT.pE 3twovED FRObI.`.TR6 EHD,PAEMiSES i ,ry <br /> DATE — <br /> SIGNATURE'OF APPUCANT a, <br /> ` DATE <br /> SIGNATURE OF RELEASING OFFICIAL: <br /> No PHS/EJ'b KEcoRas/Flt ARE ID6NTIFIEO: 'x <br /> PHSIEHD RrcoRDslFRss FUST ON TUE ADDRUS(ES)NOTED. <br /> YOU WILL BL N011F�D WREN <br /> REC0R0.Sl[11 BS ARe AVA1w p FOR REVIEW , <br /> rJUL 2 5199 f <br /> t <br />