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Tn 96h' <br /> . : : 9 14: 11 FROM TP pWPP.CS <br /> . '. t. <br /> SAN JOAQUIN COVN�I 99 _ o63 <br /> pUBLIC HEALTH 59R'"CES <br /> i <br /> ' ! HRALTH 17IVISION <br /> ENV11tOP1NIRNT2►>i <br /> B RELEASE APPLICATION <br /> PUBLIC "CORD <br /> PROSg NO <br /> I �Zca v AT7�n G _ S�� <br /> S A1`NDRE S ; I A4 L� PHONE NO <br /> it <br /> 't} t�ew�w[ywtw+ww+++xrt+r+++w**+wxttr*s+*xxxxxxx+e*xxa+ex,rx*fe,ttirie+tx*** <br /> TNESS�FML' <br /> CPl20Gi2AlR 4 <br /> I . vM i TYPE OF::FILE <br /> NC�CTL�t?TY <br /> i <br /> --- <br /> i <br /> I <br /> 11. ' <br /> THIS.NOTIC�IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUELIC HEALTH <br /> St3�VICES/E{W+RONMENTAI.HEAI.7H DIVISION (EHD) POLICY 494-007, ORDINANCE COQF OF . <br /> S JO/SQ EN COUNTY, EMD FEE AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> G' fVERNMENT CODE AND THE EVIDENCE CODE. <br /> f � <br /> 11 ilk MAXI14�UM OF TEN I=PREMISE ADDRESSES PER REQUEST <br /> 1 <br /> 2" )'p"LIC��.ES/RECORDS REVIEW IS BY APPOINTMENT ONIYs APPOINTMENTS ARE PF20CESS <br /> j ED Biy CALVING (209µ68-3A20. OFFICE HOURS FOR APPOtNTMENTS ARP SCHEDUlEO MONDAY' <br /> TNRU 1'RiD4Y EXCLUDING HOLWAYS, 8:00 AM TO 12:00 NOON AND 1:00 TO 4:30 PM. <br /> t 3i A PUf�U6 MESMECORDS RELEASE APPLICATION (PRRAI t5 REQUIRED. <br /> 4 t p1Jt3tEC F ESIRECOROS NOT RETURNED IN THE SAME COMMON AS RECEIVED WILL BE <br /> C fjFiECfEOY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> StFMCE'WILL BE BILLED TO THE APPLICANT FOR PAYMENT. WEE EHD POLICY g4- 4071 <br /> 9. 6f31NAl;PUBLIC FILES/RECORDS SHALL NOT.BE REMOV. U FROM THE EHD PREMISES. <br /> v.........a aa.....a....• ♦_ •:s.tf.irf+..Nll...�w���r�.7...• <br /> .i......... O_ DATE <br /> Slid 4TURk�OF APPLICANT <br /> I ' <br /> DATE <br /> �F RELEASING OFFICIAL ' <br /> 00!14 iR 4!R1"1 <br /> TOTAL P.02 <br /> TOTAL F.02 <br />