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(� /. J/ <br /> 9� Off <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ,/ J7 <br /> AP P L I CANT 5 f `_ �c..�L 4 PHONE NO c 0 1 f 7 <br /> ADDRESS CZ �? rv4crc Sf' <br /> AGENCY NAME 7", Lq"� PHONE NO <br /> ADDRESS <br /> FULL ADDRESS BUSINESS NAME/ PROGRAM OR <br /> FACILITY TYPE OF FILE <br /> -i��'l 'r •% ��/ �� L�/:lv (JI . ,SL,/�9Gf/�J�I��fL(�`r <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 EVIDENCE CODE. <br /> 1 . A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST <br /> 2. PUBLIC FILES/RECORDS REVIEW IS BY APPOINTMENT ONLY. APPOINTMENTS ARE PROCESS- <br /> ED BY CALLING (209)468-3420. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED MONDAY <br /> THRU FRIDAY EXCLUDING HOLIDAYS, 8:00 AM TO 12:00 NOON AND 1:00 TO 4:30 PM. <br /> 3. A PUBLIC FILES/RECORDS RELEASE APPLICATION (PRRA) IS REQUIRED. <br /> 4. PUBLIC FILES/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 /> I SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. (SEE EHD POLICY 94- 007) <br /> 5. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> +aaaaa+++asaa+♦++aa+s+a+a+a++ a <br /> - -i <br /> ++ ++++++++s++++++++++++++++++++++++++++++ <br /> SIGNATURE OF APPLICANT <br /> !�— DATE �? I � <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 9/96) <br />