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Ell 00 14 (REV 5t90 SAN JOAQUIN COUNTY <br /> PUBLIC IIEALWI SERVICES <br /> EIVVIRONNIEI` NAL IIEALTII DIVISION <br /> PUOpBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT iG/) PHONE NO_aL e co <br /> ADDRESS <br /> AGENCY NAME ( /`�(Z Un d �5 0'/u J PFjONE NO <br /> ADDRESSM It* <br /> �Z <br /> i. <br /> FILR ADDRESS LEAD AGENCY <br /> s 3VS- S4n <br /> LoP /3-T <br /> Scotch° 7664"Post-it"Routing Request Pad <br /> ROUTING - REQlUE - <br /> Please L -!t <br /> I <br /> ❑ READ To <br /> ❑ <br /> [ED IN TETE PU13UC HEAL—M HANDLE .007,ORDINANCE CODE OF SAN <br /> ❑ APPROVE FUTONS, STATE WATER' CODE, <br /> and /{ <br /> ❑ARWARD <br /> ❑ RETURN <br /> ❑ KEEP OR DISCARD APPoimi-wt TS ARS ARRA GED BY <br /> C ❑ REVIEW WITH ME 711EDULED MONDAY TIIRUI FRIDAY <br /> I IPM. <br /> Dat4---I4 �, From <br /> 3 �,' <br /> 4. PUBLIC FILES/RECORDS NOT RETURNED IN TTIE SAME CONDITION As RECEIVED WILL BB CORRECTED <br /> BY T31E END STAFF AT THE ERmsr OF THE APPLICANT. 1114151 ADDITIONAL SERVICE WILL BE BILLEDiTO THE. <br /> AITLICANT FOR PAYMPMT. (SEE EHD POLICY 94-007) <br /> S. ORIGINAL PUBLIC PI LES/RECORDS sFIALL NOT BE REMOVED FROM THE E14D PReMISES. <br /> SIGNATURE OF APPLICANT DATE <br /> SIGNATURE OF RELEASING OFFICIAL DAFG <br /> E <br /> EHD RECORDS/FILES ARB IDeNTIPIED: <br /> 11►swen RSCORDS/FILES Darr ON THE ADORESS(Tis)NOTED. YOU WILL BS NOTD7FD WNENIRIFS ARF. AVAILAZIE TOR REV16W:U.wM 1rt, 11mn A.MTN <br /> i. <br /> rJU <br /> L 2 5 199 <br /> I <br />