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I; f q5-2q D <br /> l <br /> o�411 OO 14 (REQ' 5/94) SAN JOAQUIN COUNry `1 <br /> 01 UBLIC HEALTH SERVICE'S Cvr�t 3 <br /> amu' `t ENVIRONMENTAL 14EALTII DIVISION 1. <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> I / <br /> ` ,4PPLIC T I ` ' 1 C�a/11�fq6 / <br /> �( PHONE NO l l�p 7-���� '. <br /> oADD S O 7 Y elt= f oo-P ✓ - L ( � G-f� , <br /> AGENC NAME, S 5V-a FMA: d D/lift&2�Z-G PHONE NO�� <br /> ADDRESS .I rAAc �n pyo �H <br /> 4 <br /> FILE ALIDRBSS LEAD AGENCY 12ATE <br /> 3 <br /> :' f <br /> THIS NOME IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICI~S%ENVIRONMENTALHEALTH DIVISION (EHD)POLICY #94-007, ORDINANCE CODE OP SAN <br /> JOAQUIN COUNTY, EHD FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, 7 <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1. A MAXIMUM OF TEN (10) PREMISE ADDRUSF,3 PER PBquissT. >, <br /> 2. PUBLIC FILES/RECORDS REVIEW Is By APPOINTMENT ONLY. APPOINTMENTS ARE ARRANGED BY <br /> CALLING . (209)468-0340. OFFIce 11UUR3 IOR APPOINTMENTS ARE SCHEDULED MONDAY Ttmu FRIDAY <br /> EXCLUDING HOLIDAYS, 8:00 AM TO 12:00 NOON AND 1:00 PM To 4:30 Pn1. <br /> . s.. y <br /> 3. A PUBLIC Ri$CORDS RELEASe APPLICATION (PRRA) IS REQUIRED.- <br /> I <br /> 4. PV�LIC FILES/RECORDS NOT RETURNED IN TIIC $AMC CONDmoN AS RECEIvED WILL Hli CORRECT Eb <br /> �Y TIIC ERD STAFF AT THE FXPI3NSF3 OF THE APPLICANT. TIIIS ADDITIONAL SERVICE WILL BB BILLED TO THE <br /> APPLICANT POP, PAYMENT. (SEE EHD POLICY 94-007) <br /> i <br /> S. Ow10INAL PUBLIC FILMRCCORDS S13AL NOT.)3E REMOVED FROM THE EHD PREMISES. <br /> SIGNATURE OF APPLICANT 4�-+ DAT); <br /> - I <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> NO PHS/ERD RECORDS/FILES ARB IDENTIFIED: <br /> DAnt Rmn**n jkt, NOIIFlCAT7o„DAtat ' <br /> ii <br /> ; r <br /> PHS/EHT RECORDS/FILES EXIST ON -1113 ADDRESS(Es) NOTED. YOU WILL BE NOTIFIED WIIEN <br /> RFCORD11 ILE-3 ARE AVAIUABLE FOR REVIEW: <br /> DAM i RwA wRo w, N m,,f AT(,.1 M"l <br /> ' _. ... TOTAL P.02 <br />