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SAN JOAQUIN COUNTY <br /> PUBLIC HEAL'T'H SERVICES <br /> ENVIRONMENTAL HF.At•TH DMSION <br /> PUBLIC RECORDS RELEASE REQUEST FORM <br /> INDIVIDUAL NAME PHONE NO "/W 7 Z y <br /> ADDRESS (iS L' a •�c�u1 E r ����[ 5r, C 4 S- `t <br /> AGENCY NAME PHONE NO , z c,S- if, <br /> ADDRESS <br /> FILE ADDLES LEAD NFORCE�N.'' 12AIE OF <br /> AGENCY RE UFST <br /> kion e /)o1'1rz <br /> rLC ��i)�1 t�Yln� ✓ill � <br /> or,Skt'rl ,V <br /> A YARN <br /> sANX992 <br /> MT—Courv�IIC H <br /> F.RVI�F <br /> NTAL NF. 7K Ql '—"'— <br /> San Joaquin County Public Health Services Environmental Health Division flies 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 file 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 Policy #91-001. <br /> SIGNATURE OF REQUESTING PARTY L DATE Z z It_y Z <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 3/91) <br /> �.t� . Ll(� :`1�0 <br />