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<!' •7 OCT" 1 1q4 08:28RPI 209 lip 35019 --- P.2 <br /> Ell aU 14 (REV 94) SAN JOAQUIN COUNTY <br /> PUBLIC IIEALTII SERVICES <br /> ENVIRONMENI'AL IIEALTH DIVISION <br /> MILK RECORDS RELEASE APPLICATION <br /> APPLICANT`_(, L PxoNE NO zcg / k3£f-3Sa� <br /> ADDRESS <br /> AQ l NCY NAMS PHONE NO <br /> ADDPESS <br /> 4 <br /> FILP ADDRF55 L�� IP�T�#3 <br /> i <br /> i <br /> L KN7 1.3 • w,lc,ay. �4,y cPlcla <br /> i <br /> IT t3 NO?ICH IS SUB3ECT TO THE RSQUIFFNIENTS IDENTIFIED IN TTiF MI DUC HEALTH <br /> KA - CODE OF yVICrS� IRONMI3NTALHEALT;4 DIVISION cF D (AWATER <br /> COUNTY, EHD PPE5 AND SERVICE CHACRESOLUMONS. T <br /> CTCV ERNMI;NT CODS AND THE EVIDENCE CODE. <br /> 1. A MAXIMUM OF TEN (IO) PREMISE ADDRESSES hER REQUEST. <br /> PUBLIC FILEVRECORDS REVIEW 3 av AP O�1,* rMgNj=, APwWTMWrS Ir�g ARRANGED 9Y <br /> CALLING (709},168-0340. OFPICS 110(rRS P-0R APMthrmIMvf8 APS 9CNFDUL&D MOND l7iRU FRIDAY <br /> EXCLUUINO HOLIDAYS, 8:00 AM To 12:00 NOON AND 1:00 PM To 4:3U M. <br /> 3. A PUBLIC RECORDS RELBASE APPLICATION (PIRA) IS REQUERED• <br /> C. PUBLIC FILWHECORDS NOT RETURNED IN THE SANE CONDRION AS RECEIVED IN] L Be CORREG'TEO <br /> BY THS EHD STAFF AT TRIS EXPENSB OF TAB APPLICANT. THIS ADDITIONAL SEXVIC8 'WILL i8 BILLED TO THE <br /> APPLICANT FOR PAYMENT. ME EHD PD'—'Cy 94a7) <br /> 3. ORIGINAL PUBLIC FILFSJRECORDS 51;ALL NOT BB REMOVED FROM YNB EHD mmlM w. <br /> - I <br /> SICNATURS OF APrUCANT c- DATE i 10 4 <br /> SIGNATURE OF RELEASING OFFICAL DATE <br /> No PHSIEHD RBcoP JFILES ARB IDENTMEO: �nam�wry i <br /> rl45/5N0 RECOAMMILES FX29T ON ntE AnnRESs(ES)NarED. You WILL$E NOITFIEdJ ''I'ItEN <br /> RriCURD91F1LF3 ARL A't'A7LA8f.E POA RfiV16V/: i <br /> p,.e M.w.ro.w rvmo.c.,n.t7nsa <br />