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C4i11/177: 13:10 3039800089 PINYON EPIVIRONMENT^AL PAGE 03 <br /> 94-11-1997 W"O&,l FF <br /> P.Oz <br /> f <br /> f PUBLIC HEAALTHCOUNTY �� _� 7.� <br /> PNVIRON A2, HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT <br /> ADDRESS PHONE NO <br /> AGENCY NAME <br /> ADDRESS PHONE ND <br /> rrrrrraar#rr rsa♦rterr+#+tarrraarstrarrr#r#r#rrax rater+rrrt#r#r+rw <br /> ' BULL ADDRFCS �jgSg R E/ <br /> �::�'t<krc� �ACIL�' PaO[;xrnM no <br /> ' - '�75 /aJIVinP ,a.,, a gc•a.�.I, l/CJ� I`1C ,(, �-Q� <br /> ��il Thr.cM... .V'O,w (,e na `. rPf IiCP�JnuSr C <br /> I U runes C 95 D 'lrw' ST C_O T >Q.� <br /> �cfu 'Th - . 2r1 4�.;ZC7 LLI 1�T <br /> 1 . . <br /> �'Ic:a'f•f..2.<-- C�r ,h r. . -. ;, 11 ac z.. —�L:1,,.�. <br /> r�raa•+#aaaaraaarxrrarft►trra+err###r#rttarrxr♦x ratarrrrlr♦r+rarY <br /> TMS NOTICE IS SUBJECT TO THE REQUIREMENT$ IDENTIRED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION IEHOI POLICY 094-007, ORDINANCE CODE OF <br /> SAN JOAQVIN COUNTY, ENO FEE AND SERVICE CHARGE RESOLUTIONS, STATE WATER <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. CODE. <br /> I. A MAXIMUM OF 110 UM PREMISE ADDRESSES PER REQUEST <br /> 2. PUBLIC RLSS/RECOIIDS REVIEW IS BY A ONLY. APPOINTM <br /> EO BY CALLING 12091468_3420. OFFICE HOURSINTMENTS ARE gip 1ppARC ULED MONDAY <br /> THRU FRIDAY EXCLUDING HOLIDAYS, 8.00 AM TO 12:00 NOON AND 100 TO 4;a0 pRe1, <br /> 3. A PUBLIC FUSIRECOROS RELEASE APPLICATION IPFIRAI IS REOUIRED. <br /> 4. PUBLIC FILESIRECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED 1MLL Be <br /> CORRECTED BY THE EHO STAFF AT THE EXPMsE OF THE APPLICANT. THIS AOOITIONAL <br /> SERVICE WILL 6E BILLED TO THE APPLICANT FOR PAYMENT. (SEE Bio POLICY 84. 0071 <br /> 5. ORIGINAL PUBLIC FiLESIRECOROS SHALL NOT BE REMOVED FFtOM THE CHO PREMISES. <br /> .................... <br /> SIGNATURE OF APPLICANTr , (rin OATE_y <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 MEN/ 9/961 ---�_ <br />