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ley -fib -177/ v_a•_r�.-e .... R .,z ..--- — _ --' .. _. <br />0. <br />Post -It' Fax Note 7871 <br />T/O'SLtc/ra.✓ FfOiX G-rNY' f-�� <br />/Laq)44, -3'11 5/-Z'7ea <br />97 S!_P 25 ;?1.110:52. <br />SAN JOAQUIN COUNTY <br />PUBLIC HEALTH SERVICES <br />SNVTRONMIRNTAIJ HEALTH DIVISION <br />PUBLIC "CORDS RELEASE APPLICATION <br />PHONE NO (q-/10 <br />APPLICANT LATHY 'I--' .49S+�s�4/S <br />O�cOS <br />ADDRESS , ATisPlIONS N <br />AGENCY NAME R.PA <br />ADDRESS <br />*itkit**#t#t4 ikiitt+tit*X4kx+#i*i t++#ki*t#t+4 t4t4t*tit++tt***tt*4 <br />ZLL•i. ADMR <br />� io9iYz� .✓ c <br />^- <br />z10 <br />' ltzo�V/c7'b� ,Q4 <br />. yy4as l�% CG, tlFi A+V <br />/Zcb V// Yo�C <br />THIS NOTICE IS SUBJECT TO THE REQUIREMENTS II)ENTIFIED IN THE PUBLIC HEALTH <br />SERVICES/ENVIRONMENTAL HEALTH DIVISION (EHD) POLICY A94-007, ORDINANCE CODE OF <br />SAN JOAQUIN COUNTY, EHD FEE AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br />GOVERNMENT CODE AND THE EVIDENCE CODE. <br />m Tn9a-EwR/ <br />_FACILSTX <br />Y M� <br />• . •. L.i.71 •i: <br />r.,.? • <br />'e LA <br />Fd1-S/FVG GeP /pyfIB�17YFtr <br />A MAXIMUM OF TEN 1101 PREMISE ADDRESSES PER REQUEST <br />2. PUBLIC FILESiRECORDS REVIEW IS BY APPOINTMENT ONLY, APPOINTMENTS ARE PROCESS- <br />DHBY CALLING RU FRIDAY EXCLUDING3420- OFFICE HOURS HOLIDAYS, 8:00 AM TOR12:00 NOTONENTS ARE AND 1:00 ULED O 40.30 PMMONDAY <br />T <br />3. A PUBLIC FILESISECORDS RELEASE APPLICATION (PRRA) IS REQUIRED. <br />4. PUBLIC FILESIRECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br />CORRECTED BY THE EHD STAPP AT THE EXPENSE OF THE TIONAL <br />SERVICE WILL BE BILLED TO THE APPLICANT OR PAYMENT. SEEAEHD POLICY 94NT. THIS ` 007) <br />S. ORIGINAL PUBLIC FILESMECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES- <br />................................................... 4..................... <br />SIGNATURE OF APPLICANT <br />DATE <br />SIGNATURE OF RELEASING OFFICIAL <br />EH 00 14 (REV 9196) <br />TDTRL P.01 <br />