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PUBLIC 111 SERVICES <br /> DN <br /> P LTCOWR,ONNMWAL <br /> RECORDS LEASE QUE. FO i <br /> IVIDUAL NA PHONE NO.)o51� <br /> ADDRESS <br /> AGENCY NAME -F'-r L,s / c HONE NO <br /> DRESS <br /> mei r --• <br /> F I ADDRESS j� A—DEN .Q, E MENT DATELM <br /> AGENCY— REQUEST <br /> I S D 1 tea off-CGta.v fir- cti5c <br /> (Oht/ 9 3 <br /> E <br /> b <br /> San Joaquin County Public Health SeMces Envifonmental Health Division ales are considered public records <br /> except for certain documents Identified in the Government Code and the State Water Code. <br /> Requests for public records or filb reviews are subject to charges established in San Joaquin County Rules and <br /> Regulation Environmental Health Permit Fees and Services Charges. <br /> Charges for records or documents requested by subpoena duces tecum are subject to changes established In <br /> the Evidence Code. <br /> Photo:copies of public documents are subject to Public Records Pocky 91-001. • <br /> SIGNATURE OF REQUESTING PAR DATE 3 <br /> SIGNATURE OF RELEASING OFFICIAL _ DATE <br /> EH OO 14 (REV 3/91) <br /> D � � <br />