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,11II.-22 97 08:59 FROhI:Ti,JIIJING I LIP, c-"rlhH fiCh iu -+rte*rr1.-IC3 r^ L <br /> VJ(—_=�1'C"7 " ✓JJ•41FM'1 rRl v coorata ' r,v� '.A__,-, <br /> kt�- (/ <br /> ` SAN JOAQUIN COtINTPY <br /> 4 PUBLIC RRALTH SERVIC3S <br /> SNVIiEONMENrAL HEALTH DI`II,STON <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPT.:CCANT_p prpt?t Ot <br /> ADDRESS )cre pna Jlle e 4:e-rty <br /> AGE*TCY NAME^T!.-r'rt;'n cl f <br /> PHONE NO <br /> ADDRESS <br /> #tf#tit#;iY't e,tt*'�#x#'t#t,t*rtlF,ttr#*xtt�r,rrtt'Mt*#t3f*ixr#x iirxxrYtf�rilttir4 <br /> FULL ADDRESS BUSINFJSS iV�1ME� pR9GRA.M OR <br /> FA,CILI't'Y TYPB OF FILE <br /> I 8:o KX��TrIC�-, ed/' �'e4 7`1'�6g6 Gllr —�e���� <br /> W / S4n Wprf ."owo� 1' eSc+k,i�g_ (4-r s' <br /> i <br /> *#tyxxx tixri#Mtxx#*+Y•r yryYxx'rY�**xtlxli#'f*x**/'/*#t*x�xttx*Y'��tt YYt <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION (EHD) POLICY $94-007, ORDINANCE CODE OF <br /> SAN'JOAQUIN COUNTY, EHD FEE AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE rvIOENCE CODE. <br /> 1. A MAXIMUM OF M u PREMISE ADDRESSES PER REQUEST <br /> 2, M13LIC FILES/RECORDS REVIEW IS BY 4aPPOINTIYII=NT ONLY.. APPOINTMENTS ARE PROCESS- <br /> ED BY CALLING (209)468-3420. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED MONDAY <br /> THRU FRIDAY EXCLUOING HOLIDAYS, 8:00 AM TO 12:00 NOON AND 1.00 TO 4:30 PM. <br /> 3. A PUBLIC FILES/RECORDS RELEASE APPLICATION (PRRAI IS REQUIRED. <br /> 4. PUBLIC FILFS/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. (SEE END POLICY 94. 007) <br /> 6. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT EE REMOVED FROM THE EHO PREMISES. <br /> ..........•..........a+ •Y• a.�p. •♦+.s+�s.�•+YIi�1�♦�+�+as++s.+�...•�•.... <br /> SIGNATURE OF APPLICANT �Cty-� / �-. DATE <br /> T <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 9!881 <br /> r <br /> �r <br /> �TOWL P.Et2 <br />