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I <br /> SAN JOAQUIN COUNTY <br /> PUBLIC MALTA SEIiAICFS <br /> ENVIRONMENTAL I#EALTH D"10N <br /> ,I <br /> PUBLIC RECORb$ RELEASE APPLICATION <br /> APPLICANT Tu cv�to'- °� s PIIONg NO q I s s y; ooc, <br /> I _ �_ CA 9 4111 <br /> ADDRIM ».6' CaL1C c CL«I�i lbi '1 cC Set 1 Qt.c15[c' 7 <br /> AGM4CY NAME PITONS NO <br /> i <br /> ADDP-MS <br /> pti.R A DRL�SS t.RAD AGENCY 1) <br /> l5' a- d1 tt ✓IAC Slvclt k t _ _ Sz. Tea .• Cat I tiG c Z is `% S <br /> I Ilro list <br /> SG� rv�l.Ea � 86(8xwvvj� <br /> I' <br /> i <br /> THIS NbttcE 15 StIBtECT TO THg ktQUlnMnNT§ Ibti"inEb IN''PHE' PUBt2O HEALTH <br /> sgRViCES/ENVIRGNMgNTALHEALTH btVIStGN (Ettb)Poi1cY�92�01, oBbtNANCE CtlbE OF SAN <br /> )oAQUtN couNTY, Btib FMgS ANb SgRV10E CRARGE RESOLIhMONS, STATE WATER CODs, <br /> oOVERNMENT COb9 AND THE avIDENCII CObE. <br /> I. A MAXIMUM OP TEN (10) PREMisg AODRBSSES PER REQUBST. <br /> 2.' pUguC FILB4/RECOt1bs REVIEW ARE BY APPO»=Mt;MLtlNLY,' A"otNTMIINTS ARE <br /> ARWanD BY CALLtNd (20)469-W40. OFFICE HOURS POR APPOINTMENTS Alto SCHEbULBt) <br /> MoNbAY THRtf MUI) 4t llxcLUDING HOLIDAYS, 9:00 A.M. TO 12-oo NOW ANI) t:bo P.M, TO 4:3o <br /> P.M. WAG- <br /> c <br /> 3. A PUBLIC RHCORbS RELEASE APPLICATION A <br /> �' �I[Yt' AV'11 lnt n ttn.ra,�e +w+n ..e+e•rnnv nn rtln n +r. <br /> 4. <br /> S. PUBLIC PILM/RECORbS NOT RMRNHb IN THE SAME CONDtnON AS RECMVEb WILL BE <br /> 1 Cof "c"TEb BY THE $HI) STAFF AT THE EXPENSE of THE APPLICANT, THIS ADb1T1oNAL <br /> SERVICE WILL BE BtLLEI) to THE APPLICANT PDR PAYMENT. <br /> 6.. CTRIoiNAL PUBLIC FILgS/RHCoRD9 SHALL NOT BE REMoVEb PROM THE BID PREMISES. <br /> LI <br /> SIONATURE LICA <br /> OP APPNT �u Y t bAT. 2 13 q j <br /> r SIONATURP OF RELEASING OFFICIAL BATH <br /> EH oo 14 (REV 12192) <br />