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Ell UU 14 (REV 5194) SAN.JOAQUIN COUNTY <br /> PUBLIC 11FAl:l'II Sl+RVIC1US f W ��- <br /> E.NVIItUNMENI'AI, HEAL'I11 DIVISION <br /> PUBLIC ItECONDS RELEASE APPLICATION <br /> APPLICANT' �J'� ! ����, �{ ,��/l PHONE NO <br /> ADDRESS . <br /> AGENCY NAME d'r��% un ct ! �O c./c/,W3 <br /> PHONE NO <br /> ADDRESS f ; •� �)��k c> ? �'+ - <br /> . V <br /> _ — A <br /> - P <br /> FILE ADDRESS LEAD AGENCY DATq 44E <br /> li <br /> O -s ' "c I ! 1 f,n 1 c1- r`.I Ifs y cop vim, rf Y_ .29•��- <br /> �o. Lv /-�." �i l��/-ems•"^�— 3sz c, <br /> (�, �. ref r/r �:acr S /•1 I rr,,6 ] 1 )—:2 _ 3 v <br /> _3, <br /> T'IIIS NOTICE ES SU13JI-ic'1'O THE ItFQUIRIIMIiN'1'S IDENTIFIED 1N THE lIU13LIC lil?AL'Ill <br /> 51iltVICI:S/L.NVI€IONMI-,N"1-AL III:AI.;E'lI DIVISION (LAID) POLICY #94-007, ORDINANCE, CODE 01;SAN <br /> JOAQOIN COUNTY, l:Ill) 11"1133 AND SERVICE CHAmm. RUSOLU-1'IONS, S'I'A-i'13 WAlliit COD11, <br /> GOVERNMENT CODE AND'11.1E UVIDENCE CODE. <br /> I. A MAXIMUM 0F'1"EN (IU) PREMISE; ADI)Rl,-ssi:s I'I:R RlaQuf:S"1� <br /> ' 2�'� I'Utll-IC I'Ifs€:S/RIiC:UItDS�ItIiVIi;W IS I1Y nI'l'OIN'I"MLNIONLY. AI,I'0IfJ"I'AII:N'T5 ARE ARRnN017-1J BY <br /> CAI,LIN() (209)4(il(-(1340. OFFIrn IIOUPS FOR AIPPOINTNIFNTS ARI; SCIIEDULED MONDAY TIIRU 1'RIDAY <br /> LXCLUIJINO HOLIDAYS, B:(K Ant To 12:00 NOON AND I:U() m 'ro 4:30 PM. <br /> 5 <br /> 3. A 1'UIILIC RECORDS RELEASE APPLICATION (TERRA) IS REQUIRED. <br /> ' I.1 ESIRL''CORDS NOT RI:I'URNI:D IN 'mu. SAMIE.CONDITION AS RECSIVL"sD WILL IJI COR Ill Cl <br /> 4. I UI1L[C L <br /> [lY -rim- Li1113 STAFF A-r -rim uximN'Sr OF TILE APPLICANT. 'IIIIS ADDITIONAL sE.RVICr WILL. BE 811-1,ED TO TLIE <br /> APPI.ICAKr FOR PAYM1ICN"1'. (SCI EHD POLICY 94-007) <br /> S. ORIUINAL PUBLIC 1'1LES/RECORDS SHALL, NOT 8E RCMOVCD FROM TILE MID PREMISES. <br /> SICNA'I'URE Or n1'1'LICAN'C�.---� DATE -S <br /> SIGNATURE OF RELEASING OFiFICIAL DAT U, <br /> NO PlISIC-11D RECORDS/fILCS ARC IDEN'rIFIED: <br /> DMT: Apwwwph NTT A71MCATIEW DAM <br /> PIIS/EIID RrcORDS/FILES rxlxr oN IIID ADDRCSS(ES) NoTrsD. ;YOU WILL DE NOTIFIED WIZEN <br /> Itrumms/FILF,S ARF AVAILABIX FVR REVIEW: <br /> DOTI! An"m m%Tr KnVIIf A"l*l PAyn! <br />