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SAN JOAQUIN COUrrrY <br /> PUL31., I:C HEAL'I'll SI RVICIsS <br /> ENVV:I:RONMf;1\1'I'A1, IIEALTII DIVJ:SlON <br /> PUI3LIC RECORDS RELEASE APPLICATION <br /> APPI, fCAN'I' �(i(I GSL y (�I,II.L ��l��l PHONE NO J L L' <br /> AUI)RLSS__ <br /> AGENCY NAfIE _r. ► PHONE NO <br /> ADDRE'S S 14 _ - <br /> * k# k k * k k k * -k k k k * # * k k * k k#* k k k * k* k** #* k# * k'k* k# k*** k k k* k k'k *'k#*#**# <br /> FUI.I_,. ADDRESS 13USPROGRAM OR <br /> TYPE OF E:IL,E <br /> 5, �lcs �� ci— �'r(( lr'( �tr `>1iF (( � `er�t C js. z ' <br /> k } k k k k * * * k * or * k* * # k k <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION (EFIDI POLICY #911-007, ORDINANCE CODE OF <br /> SAN JOAOUIN COUNTY, EHD FEE AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1 . A MAXIMUM OF TEN 101 PRENIISE ADDRESSES PER REQUEST <br /> 2. PUBLIC FILES/RECORDS REVIEW IS BY APPOINTMENT ONLY. APPOINTMENTS ARE PROCESS- <br /> ED BY CALLING (209)168-3420. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED MONDAY <br /> HRU FRIDAY EXCLUDING HOLIDAYS, £3:00 ANI TO 12:00 NOON AND 1:00 TO 4:30 PM. <br /> 3. A PUBLIC FILES/RECORDS RELEASE APPLICATION (PRRA) IS REQUIRED. <br /> ,I. 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 /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. (SEE EHD POLICY 94- 007) <br /> 5. ORIGINAL PUBLIC FILES/RECORDS SHALT_ NOT BE REMOVED FROM THE EHD PREMISES. <br /> ... . . .1. . . . . . . . ... . . . . . . . . .. . .. ... . . . . <br /> • • . • • . • . • • • • • • • . • • • • • • . 7 <br /> —7 • <br /> SIGNATURE OF APPLICANTo�L%Lj` • •����' DATE I` <br /> SIGMA l-URE OF RELEASING OFFICIAL DATE <br /> 1:1I m) 14 (REV 9/96) <br />