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SAN JOAQUIN COUNTY <br /> �► PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION 3`f �I <br /> PUBLIC RECORDS RELEASE REQUEST FORM <br /> INDIVIDUALNAME PHONE N q l(v 3S <br /> ADDRESS c�. '?i SCr, Cayrt.c Llot�k�s c;� G 1 l <br /> AGENCY NAME �o r cti�c( �t �s arm PHONE NOCAtt,--12 9 - 21Z2 <br /> ADDRESS <br /> FILE ADDRESS LEAD ENFORCEMENT DATE OF <br /> AGENCY REQUEST <br /> �j3c� Utckw2c t tt,v+ t,m� Ijl U,y +mt I tt-zt -�S— <br /> I <br /> San Joaquin County Public Health Services Environmental Health Division files are considered public records <br /> except for certain documents identified in the Government Code and the State Water Code. <br /> Requests for public records or file reviews are subject to charges established in San Joaquin County Rules and <br /> Regulation Environmental Health Permit Fees and Services Charges. <br /> Charges for records or documents requested by subpoena duces tecum are subject to changes established in <br /> the Evidence Code. <br /> Photo copies of public documents are subject to Public Records Policy #91-001. <br /> SIGNATUREOFREQUESTING PARTXI�[(/�Ilb7� DATE - <br /> w <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 3/91) <br />