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JUN—:.1-1999 12 :06 PM TPICK llP.EESSt11 TO <br /> 05-1:-1999 10.5 MM F# <br /> 99-145 <br /> SAN JOAQUIl4 CCU^ITY <br /> ptIBLTC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DlvieION <br /> MLIC RECORDS RELEASE APPLICATION <br /> �fieGSse nPHONE NO <br /> NT <br /> � 5 Z '3502 <br /> APPLICA �te� �,ia tom_ e 9 — <br /> ADOR.Bas �HONB NO__. <br /> AGENCY �— <br /> ADDRESS <br /> rA AA.ArrrrrrfaAriYfalYaAAr<Y<r YAi+faaararr+rrtarrr rYY<'rr Aaarararra <br /> Ba2SliEaa_nMEL rrzocl:nrl oTt <br /> FULL ADDRESS T.w�+7 ,TTY mu OF FILE r+ <br /> tQ, p`ic_W. F{E yP 0 ,,q 'Al 48 D lint to nq co rtf��w.•.eC <br /> ? t;oti _,l lT �nv<s Eijpl=�w. <br /> rYlAW iYYAaiaafa#arYrJYAAYArf#frraa•rrf#k1a+f YAalrY1lrrtr!##Yr A<k! <br /> THIS NOTICE IS SUBJECT TO THP F(FQUiRP1vMNTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVIcm/ENVIRaNMWTAL HEALTH DIVISION 040) POLICY 194.007. ORDINANCE CODE OF <br /> SA C CODE AN,❑THE HFEE A140 E EVIDENCE.SERVICE <br /> CRAROE RESOLUTIONS. STATE WATER CODE, <br /> a0v <br /> 1. A MA70MUM{IF=LM PREMISE ADDRES5ES PER REQUEST <br /> 2, PUBLIC PILES/RECOROS REVIEW IS BY APMl_UWA ONLY. APPOINTMENTS ARE PROCESS- <br /> PD 6Y CALt ANG (2091468-4420.OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED MONDAY <br /> TI IRU FRIDAY 9XCLUDING HOLIDAY-4..0:00 AM TO 12000 NOON AND 1:00 TO 4:00 FM, <br /> 0. A PUSUC RLES/RECORD3 RE.EASE APPLICATION (PRRA) IS REOUIRHD. . <br /> 4, PUBLIC F1LE97RECO ADS AOT RETURNED IN THE SAME CONDITION AS RECEP/EO WILL BE <br /> CORRCCT80 BY THE CHO STAFF AT THE EXPENSE OF THE APPLICANT, THIS ADOI710NAL <br /> SERVICE WILL BE 6LLM TO THE APPLICANT FOR PAYMENT. IS"EMD POLICY 94- 0071 <br /> 5. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED :FOM THE EHD PREMISES. <br /> •.arr•♦l++r.araf.r.r•r............ <br /> SIGNATURE OF APPJCANT fS / /L� �•• iW/1>1'L�DATfi /° P <br /> SIGNATURE OF RELEASING OfFiCIAL DATE_ <br /> EH 00 14 IREV 9/981 ' <br />