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SF <br /> SAN JOAY V71/� P <br /> QUIN COUNTY � <br /> PUBLIC HEALTH SERVICES <br /> ozb <br /> ENVIRONMENTAL HEALTH DIVISIOpERM�M�cNT�C 79 99 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> PHONE NO a87 <br /> �IPLICANT C <br /> AI DRESS11161111 IF I;wr-21 <br /> �C" ]?HONE NO <br /> Al.-ENCY NAME <br /> A: DRESS <br /> # •#t#t�rt#t*ttir*#*#�[t'ktf***tt#**t##ttit#t#t**•}t#*;*#*##yr*#t�l'+kt#tt#t <br /> OR <br /> � 1Lk ADDRESa BUS NE SNAMES YPE OF F LE <br /> FAVI 4�TTY <br /> gaff <br /> it#t*tt# <br /> k1f*tt#fir#ir#*#*#irtt•tt### Ir#•kit#t•lrtk****i'ti###ir�lr+'tlrtir�riF�ric�rir#tirf <br /> IDENTIFIED IN THE PUBLIC HEALTH <br /> (PIIS NOTICE 15 SUBJECT 70 THE REaUIREMENTS VIS ON i HD1 POLICY #94-007, ORD NANCE CODE OF <br /> 3ERVICESIENVIRONMENYAL HEALTH D! <br /> 3AN JOAQUIN COUNTY, EHD FEE AND StiRVIDE CHARGE RESOLUTIONS, STATE WATER COQ , <br /> GOVERNMENT CODE AND THE EVIDENCE C <br /> 1. A MAXIMUM OF TEI L 1 PREMISE ADDRESSES PER REQUEST PPOINTMENTS ARE PROCESS- <br /> 2. PUBLIC FILESIRECORDS REVIEW IS 8Y AP OIN;HENT ONLY. <br /> ED BY CALLING (209)'468'3420. OFFICE HOURS FOR APPOINTMENTS <br /> NOON ANDA100 TO 4D30 MMONDAY <br /> THRU FRIDAY EXCLUDING HOLIDAYS, B-00 ATVI <br /> 3 <br /> A PUBLIC FILESIRECORDS RELEASE APPLICATION (PRRA) IS REQUIRED. BE <br /> 4. PUBLIC FILESiRECORDS NOT RETURTl ECAP CONDITION <br /> THIS ADDITIONAL <br /> CORRECTED BY THE EHD STAFF A7 THE EXPENSE OF <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT, iSEE EHD POLICY 9 REMISES. <br /> 5. ORIGINAL PUBLIC FILESIRECORDS SHALL NOT 8E REMOVED FROM THE EHp Pa•*.•••a a*a• <br /> a•s•a.aa.aa.aa•a.••aa.aaaaaaaaaaaaaaas.a•aaaaaaaa DATE04�>— <br /> _ <br /> SIGNATURE OF APPLICANT <br /> ELATE <br /> SIGNATURE OF RELEASING OFFICIAL <br /> EH 00 14 (RFV 919$) <br />