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.4 aV.a. YaVo xta vvvl .auu a..a uuv�..� ��/�I vv,.__ <br /> 66-12-199A 02:11 RM. FRTt V� 44250E1 P.02 <br /> I Vii f Q' <br /> Ell C10 Id (REv 5194) SAN ,10AQUIN COUN'T`Y <br /> PUBLIC UEAILTII SERVICE'S <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> GAPPLICANT' <br /> c�[w � fOA) ?HONE NO -98G O�sd <br /> ADDRESS 1 (9715- F -5-r YR6s�, G 4 4 S 70fa <br /> AGENCY NAME 'PHONE NO — <br /> ADDRESS I <br /> FLI L3 ADDRI FSS LEAI} AGfitdCY DATE <br /> O 7=SG�ST IVgl.p(co `I�A�Y,Ga o7 . <br /> O LOO I1AL,Pled T.[ACP�GA <br /> SAGPIGo RD t'RA� 4f <br /> l3y44v o.L P,T S W CURNAeI eF t1'1AcA.Q'JUG r UP+P,c.o K 64 - <br /> '7= <br /> I <br /> I <br /> i <br /> TLHs Nan Is SUMECT To THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/E VIRONMENrAL HEALTH DIVISION(END)POLICY#%"W,ORDINANCE CODEOFSAN <br /> JOAQUIN COUNTY, EHD FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNIXIEVg T CODE AND THE EVIDENCE CODE. <br /> 1. A M OF Trx (10)PREMISE ADDRESSES PER R6QUH47. <br /> 2. PvbL FILES/RECORDS REVIEW is BT APPOIN'Cir1fiNT ONLY: Aipow MEN s ARS ARAANcED By <br /> CALLING (20%469-0140. OFACB HovRS FOR APPOINFMENIB ARO SCHEDULED MONDAY TIIRU FRIDAY <br /> EXCL.UDLNO HOLIDAYS,8-00 Ani TO I2--00 NOON AND 1:00 PM To 4:90 PM. <br /> 31 A PtnsGC RfiC00.Ds RELEASE APPLICATION (PRRA) IS RE'QUIkED. <br /> A. PUBLIC FILES/RECORDS NoT pHm"W IN THE SAM&CONDI?Oto As RECEIVED WILL DE CORREC7ED <br /> 8Y TM EHD �T'AFP AT THE EXPANSE OF THE APPLICANT. THIS ADDMONAL etS[VICE WILL RE RIr TR TO -nm <br /> APrLK-.ANr Potje PAVMENr. (SEE END Po1JcV 94-W7) <br /> S. ORIORIAL P"JC FILESIRECORDS SHALL NOT BE REMOVED FRom THE EHD PREMISB4. <br /> SIGNATURE QP APPLICANT DATE J P <br /> SIGNATURE P F RELEASING OFFICIAL DATE <br /> I <br /> No PHS/EK D REcoR VTW ARS IDENnFmtr <br /> G„s p.mm rn NomJM1e.v.Tx <br /> PHS/EHD Ra'CoR0.5/FO.ES EXtST ON THR ADDREsS(PB) NarED_ You wtu.RE NOTIFIIM WEEN <br /> RECORDS/P/1.SS ARE AVA11ABLE FOR REVIEW: <br /> W*Q bnNs m He..nd*i�b� <br /> 1 <br />