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SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRON-MMAL EMALTH DMSION <br /> PUBLIC RECORDS RELEASE REQUEST FORM <br /> PHONE NO y(6 - 3-7 z - 1/2 <br /> V <br /> INDIVIDUAL NAME •� ' r 4i 1 e F?1 z -S <br /> ADDRESS 3vs-u �dk Frr� �(��! S� c . <br /> AGENCY NAME PHONE NO z C,s- ` '--a Y i0 <br /> t ADDRESS <br /> LE ADD ESLEAD—F-EFOROM <br /> AGE NGY s <br /> A 04 l z-2 -( -f z <br /> E� 'fcc � 'r n f�✓��Y'Tiv�^S�+ � �4c:frf . <br /> 4 <br /> R � N <br /> ' S 992 <br /> 13UC H—ITYU COVN <br /> +-• NTA ERv�CES <br /> HDMWON <br /> San Joaquin County Public Health Services Environmental Health Division files are considered public records <br /> except for certain documents identified.in the 00"rument Code and the State `)Vater Code.- <br /> l4quests 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 far records or documents requested by subpoena duces tecum are subject to changes established la <br /> the Evidence Code. <br /> Photo eoples of public documents are subject to Public Records Policy#91-0301. <br /> a <br /> SIGNATURE OF REQUESTING PARTY � DATE c�Y 9 Z <br /> SIGNATURE OF RELEASING OFFICIAL. DATE ... <br /> z <br /> EH 00 14 (REV 3191) <br /> *,. f 'e <br />