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SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> _ Yti1�crQE PHONE NO <br /> APPLICANT <br /> ADDRESS Ti PHONE NO <br /> AGENCY NAME <br /> ADDRESS <br /> pus rress NAMEPROTR IM oft <br /> Ui,f� 11lJUR SS SVtcz JZACILI'I�Y TYPE OF FILE <br /> y h <br /> Ec—z <br /> �. C.ue.� <br /> c;c-2 �i—� <br /> �Cot�L?F�.� �-4fa�t*c�..� (ZO . l I`- �/`fY t...+�N�—'3tT� 3w�>.-c�� �t1 `t uc�•� <br /> Lr r QST_ <br /> -gLL� ��cv-�� ��c.� _Lf�'tN2L�� '�FE�ltir� oc N1Ut�t�CV.Frc�ILC <br /> kc—r-- <br /> rill lz <br /> Cr--I�yE <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH 1DISERIQICE CHARGOEICY RESOStU�ION© STATE WATNCE EDE OF <br /> R <br /> CODE. <br /> SAN JOAOUIPI COUNTY, EHD F <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1 . A MAXIMUM OF TEN IL01 PREMISE ADDRESSES PER REQUEST <br /> 2. PUBLIC FILES/RECORDS REVIEW IS BY APPOINTMENT ONLY. APPOINTMENTS ARE PROCESS- <br /> ED BY CALLING 12091468-3420. OFFICE HOURS FOR APPOINTMENTSARE SCHE4D30 ULED MONDAY <br /> THRU FRIDAY EXCLUDING HOLIDAYS, 8:00 AM TO 12:00 NOON AND <br /> 3. A PUBLIC FILES/RECORDS RELEASE APPLICATION (PRRA) IS REQUiRED. <br /> it. PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY >THE <br /> LIED OTHE APPLICANT <br /> FOR AT THE EXPENSE P PAYMEF THE NT. SEE EHDPOLICY 4—PLICANT. THIS 007 AL <br /> SFl�V1CF WILL <br /> 5. ORIGINAL PUBLIC FILESIRECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> r • r r • a ♦ s r a s t f• r r r r a r a r r a r ♦ r • r r+ r a r r r r r t a♦ r r♦a* r a r i a r. .. .. .. . <br /> ��• r r s a w <br /> -i f , DATE <br /> SIGNATURE OF APPLICANT ' <br /> SIGNATURE OF RELEASING OFFICIAL <br /> DATE <br /> EH 00 14 IREV 9/961 <br />