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SAN JOAQUIN COUNTY td (�(� > <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE REQUEST FORM <br /> .• INDIVIDUAL NAME MPH � 54n144i PHONE NO <br /> ADDRESS 761 — c-1221a zz <br /> AGENCY NAME e (^(t ra? PHONE NO LI"-23-- <br /> ADDRESS <br /> l'73-ADDRESS V I&A , <br /> FILE ADDRESS LEAD ENFORCEMENT DATE OF <br /> AGENCY REQUEST <br /> V 2 - 31 <br /> P <br /> RECEIVES? <br /> SAN.JOAQto <br /> San Joaquin County Public Health Services Environmental Health Division files areWARIcXecor S , <br /> except for certain documents identified In the 0overnment Code and the State Wa ` `�� E" � <br /> Requests for public records or rile 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 /> i <br /> Photo copies of public documents are subject to Public Records Policy #91-001. <br /> i T _ <br /> SIGNATURE OF REQUESTING PARTY : ,ur1c DATE <br /> f <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 3/91) <br /> i <br />