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I <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL ItEALTH DMSION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT PHONE NO 4 3V <br /> i- <br /> ADDRIIM 3 L I^n -CaGlerc C[ J-pr lb'itl 1'IcCr 5a, f-'ZltlljSCL' f Cl a 4111 <br /> AGENCY NAME PHONE NO <br /> ADDPJESS <br /> MX ADDRESS LEAD AGENCY DA173 <br /> j5 J•�d< si+;aP 1�✓i�t , S(vcLlot, Sz .Toat L.-, (i'tt•J�, 1'46-1 L is 415 <br /> fih <br /> I6z'4— fbi. av <br /> TT3ts NbItC13 15 SUBJECT To THE kbQtA"MBNTS Ibj3"PMt) IN THE" "LIC HEALTH <br /> SERVICnSMNVIRONMgNTALHgALTH t)MSION(ltttb) POt1CY N92-WII MWtNANCg CObg OP SAN <br /> JOAQUtN COUNTY, SND 17VM AND SERV1CV CHARag RESoLUTtONS, STATE WATER COD$, <br /> aoVERIJMENT CODE AND THE EVIDENCE CODE.', <br /> 1. A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST'. <br /> 2. PUBLIC mm/liCWWS REVIEW ARE 13Y APPOINTMRNT ONLY,' A"otf"WT'S ARE <br /> ARRANGED 9Y CALLING (209)469.0340. OFFICE IIoURS FOR APPOINTMENTS ARt SCHEDULED <br /> MONDAY THRU PRIbAY EXCLUDING HOLIDAYS, 9:00 A.M. TO 12:00 NOON AND J!00 PA To 4:30 <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION A <br /> 4 <br /> 5. PUBLIC FIIM/RECORDS NOT RETURNED iN THB SAME CONDITION AS RECEIVED WILL BE <br /> CoWcTgb EY THE W40 STAFF AT THE EXPENSE OF THE APPLICANT, ` THIS ADDITIONAL <br /> sBRVICn WILL Eg EILS.ED TO THE APPLICANT FOR PAYMENT. <br /> 6. (iRIOINAL PUELtC PILMI ECORDS SHALL NOT Bn REMOVED FROM THE EHD PREMISES. <br /> SIONATUOF APPLICANT �u Y t DATE ti 13 <br /> RE �q j <br /> SIGNATURE OF RELBASINa OFFICIAL DATE <br /> EH 00 14 (REV 12/92) <br />