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SAN JOAQUIN CO Y <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE NPPLICATTON <br /> AF'P L I CANT <br /> + HONE NOr/.f ~ <br /> ADDRESS P1ONE NO <br /> AC ENCY NAME Z <br /> AE,DRESS <br /> *r +ttttt*twwtw#***+�rtttt#t*#w+tttw*t#w **tw#!r#**ttwtt##**tttww*,t* <br /> BUSINESS NAME PROGRAM R <br /> FILL ADDRESS FACILZT TYPE OF FILE <br /> 7r" <br /> Th;IS NOTICE IS SUBJECT TO THE REQUIREMENTS 1bEN IFIED {N THE PUBLIC HEALTH <br /> E Or <br /> SERVICESIENVIRONIME T L FHEALTH [ IS SERVICE(EHO)CHARCiEIRES#94-00 ,O SRIATE WATERNCE CODE, <br /> SE-N JOAQUIN COU <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1. A MAXIMUM OF TEN 10 PREMI5E ADDRESSES PEF REQUEST <br /> 2. PUBLIC FILES/RECORDS REVIEW IS By APPOINTMENT ONLY. APPOINTMENTS ARE PROCESS, <br /> Ell BY CALLING (209)468-3420. 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 FILES/RECORDS RELEASE APPLICATION I J BRA) IS REQUIRED. <br /> 4. PUBLIC FILI SIRECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> ITIr�NAL <br /> CI)RRI=CTED BY THE EHD STAFF AT THE EXPENSE OF HE APPLICANT. THIS ADD <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. (SEE~ EHD POLICY 94- 007) <br /> 5. ORIGINAL PUBLIC FILESIRECORDS SHALL NOT E3E EMOVE:D FROM THE EHD;iPRi=MISES. <br /> •. ff�a..�r���r••��as��• ff�w�lar�+tf�•��• fflfffffff���••f ff•i����1i t•\f�ft <br /> SIGNATURE OF APPLICAN DATE <br /> SIGNATURE OF RELEASICs OFFICIAL DATE <br /> El 100 14 (REV 9/96) <br />