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tzi z 7/a e tun to-j% rna cva-ayo'volt- ua.oataraa.ucat +�� rnof rsw ~ 1►fvvi "— <br /> '/,Aye e•���r��A <br /> ®v3 <br /> SAN JOAQUIN COUNTY ` <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT CSN HONE NO CZo,9ts9� " <br /> ADDRESS <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> .smear****�*t#t,t:#,r*t#,r*:t*t******• t**w•�a*�*�dr*r�,r**f*�r���*:*t,rt#**� <br /> FULL ADDRESS BUSINESS NAME/ PROGRAM OR <br /> FACILITY + �^ TYPE; OF FILE <br /> • �c.�'D E. �Q/�-� SRP AV-44`i 2SfC-'' <br /> • t t 5: !41> asS Gt�s uuvPS;�u�•e z,4 ! f4�c.- <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICESIENVIRONMENTAL HEALTH DIVISION (EHD) POLICY #94-007, ORDINANCE CODE OF <br /> SAN JOAQUIN COUNTY, EHD FEE AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1. A MAXIMUM OF TEN 1101 PREMISE ADDRESSES PER REQUEST <br /> 2. PUBLIC FILESIRECORDS REVIEW IS BY APPOINTMENT ONLY. APPOINTMENTS ARE PROCESS- <br /> ED BY CALLING (2091468-3420. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED MONDAY <br /> THRU FRIDAY EXCLUDING HOLIDAYS, 8:00 AM TO 12:00 NOON AND 1:00 TO 4:30 PM. <br /> 3. A PUBLIC FILESIRECORDS RELEASE APPLICATION (PRRAI IS REQUIRED. <br /> 4. PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. (SEE EHO POLICY 94-007) <br /> 5. ORIGINAL PUBLIC FILESIRECOMMS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> •e®e®wee�s®a.s•stwe.a• • • •s®e®e®ess•®•e•eewwe®e••ts ♦.• •®®ww•♦se®• <br /> SIGNATURE OF APPLICANT DATE <br /> SIGNATURE OF RELEASING OFF(CI L L� DATE U"I �� • <br /> EH 00 14 (REV 9/961 <br />