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IF <br /> 411 <br /> '§ <br /> „ SAN JOAQUtN c0VNT•Y # I <br /> P11I30C UPAL` H SIER"cvq <br /> CNV RONMENf'AL UPAL-M Desist' <br /> IP"LIC RICO"S REL ASE REQUEST FORM <br /> INDIVIDUAL NAMES-t l Ut, PI-ZONE NO : <br /> ADbRE5S z(ti70 rt L,v a o•p LA to� R ��{Z <br /> AC3ENC'Y NAME i� PHONE NO <br /> ADDRESS vS iii v ( -7_Q.Z�1 <br /> ESS p <br /> A{�f�y. NFog� DATE 0E <br /> f-i.:� 8EOUEST <br /> u tcr- G <br /> ! Ll3 rti fh-e It+,uu S <br /> L,010 LAW a r , Lc w�S Loc w L <br /> O� we n u G <br /> Lt By oS• i�4 - �. <br /> ,an j I Ulf l'I W cW ht.r <br /> N El[tt9A I� SoW. (-WV4- <br /> k14b rkc ill $ I,J• �A,i Cy TS <br /> �" r � • u Lc c� <br /> .p <br /> san Joaquin County Public HeAlth Setweet 13t1vitanttteHtai Health Dlvislon flies Art'considered public <br /> except rot certain document Idthtliled In the dovetntttenl Cade and the State Wates Code, records <br /> Requests for public tewrdt at Ale tevle"ate aub)eet td tshat$es estAbllshed to Sen Jdequin County Rules and <br /> Regulation j!nAtottrnental Health petmlt Peet and Sefid6a chatget. <br /> Charges for records of documents requested by subpoena duds tecum Are subject to Changes established to <br /> the Evidence code. <br /> Photo copies of public documents are tubjw!to public Records Policy #ogi-ml. <br /> 9 r <br /> SIGNATURE OF RP-QUVsrjNC3 pAftTy bA'TL <br /> SIGNATURE bF RFLEASINC;O FIcIAL DATE . <br /> EN 00 14 (REV 3/9!) .� <br /> f <br /> ! j <br /> - _ '� 4 r <br />