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—• PUBLIC HEALTH SERVICE <br /> ENVIRONMENTAL HYALTII DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION (7-7— <br /> APPLICANT S A. —PHONE NO_�vLj (,((4 - 35I'a <br /> ADDRF-55 1913 —Ir�I Fc Rd crcA �tkAA,iM C, lfnllf , +-7 <br /> AGPNCT NAME N w PRONE NO Ga, <br /> An)fig LEAD AGENCY <br /> 5z5 _ GRh +L.u� 2 T SSCDfN <br /> 3S. a <br /> . jt';L w.G Lw.s LSjc <br /> San w. (+ {�.u_ Qc{ 1� CTcD4 tf 35- <br /> GT'w•(�een"ft t D.I �"�'rns(k <br /> TH15 NO'hCE IS SUH.IECT TO THE REQUIREMENTS IDE1`ITIFIED.IN THE PUBLIC HEALTH <br /> SERV tCE*rENvIRONMENTAL HEALTH DIVISION(EHD)POLICY 994-007,ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY. E14D FEES AND SERVICE CHARGE RESOLITIIONS, STATE WATCER CODE. <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> I. A MAxIMUM OP TEN(I0)PREMISS ADOREMSES PER REQUEST. <br /> 2. FdBI[c FILESIMORDS REVIEW Is BY APPOINTMENT ONLY, APPOINMENTY ARE ARRANCED BY <br /> CALLING (209}9664340. OFFtCB IIOORM FOR APPOUlI7.1ENT3 ARB SCUEDUIED MONDAY YIIAU FRIDAY <br /> EXCLUDING HOLIDAYS, &00 AM To 12.00 NOON AND 1.00 PM To 4.30 PM. <br /> 3. A haus Krcostm RELEASE APPLICATION ('RRA) IS REQUIRED. <br /> d. PUBLIC FILESIRECORUS NOT RETURNED IN THE SAME CONDrrloN As RBCEfyw w1LL as CoRA6CTED <br /> BY TiiE @41) STAry AT THE rxrENSE OP THa APPLICANT. THIS ADDrMNAL SEAVICE WILL Ea BILLED TO THE <br /> APPLIcAm(FOR PAymmir. (SES EHD PoucT 94-00>) <br /> 5_ ORIDWAL PVeuc FILESIRECORDS sHu.l.NOT e`sKEmOYED Fium THE EHD PREMISES. <br /> SIGNATURE OF APFLJCANT U DATE z. <br /> SIUNATU4EOF RELEASING OFFICIAL DATE <br /> No FMV/ HD REcoRDS/FH.EM ARE BIQNTIFIED- <br /> num w....w.rn ]RTfKRncw W+. " <br /> PASlEHD RECORDSJFa.w gxirr ON THE ADDRESS(EM)NOTED. YOU WILL Bk T10TIPI[D W1t=' <br /> RECOADSII•ILE.S ARE AVAmAam roR RSTIM <br /> AN RY.d-M�M Ib.InC....�Oen' <br /> TOTAL P.92 <br /> �,� ��U1l <br />