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FEB-14-1996 1009 f-RFSGEOLIMCOL TEC1I11ICS TO • 4640138 P.02 <br /> EH OO 14 {REV 5144) SAN JOAQUIN COUNTY <br /> PUBLIC IIEALTII SERVICES F,lla- ��1i ecAJ <br /> ENVIRONMENTAL IIEALTII DTWISION <br /> PUBLIC RE CORDS RELEASE APPLICATION 9(o <br /> APPCiCA NI S 7p rell P , NE Na 3V- �eje <br /> ADDRESS : v r s <br /> AGENCY NA&W PRONE NO <br /> ADDMS <br /> AmT m LEAD AQEN— 'iDATE <br /> oa57rfc <br /> • o ttc 'f—ro�rT r r 13�s.,r�-� �.Ya7 S S <br /> i <br /> inns NOTiC IS St3H7ECT TO THE REQUIREMENTS 1DLN7IF ITT} IN THE PUBLIC HEALTH <br /> SERVICES/EN RONIYMENTAL HEALTH DIVISION(SID)POLICY 04-007, ORDINANCE CODE OF SAN <br /> JOAQUI14 COUNTY, $FID FEES AND SERVICE CHARGE RES08.UTIONS, STATE WATER COD& <br /> COVERNMENir CODE AND THE 6VIDfiNClz Com- <br /> 1. A MAXIMUM OF TEN (10)PREM99 ADDREMES PER REQursyr. <br /> 2. PUBLPd.Fn CORDS P EVMW IS RY AMOINIMSNT ONLY. APPOINIMEN13 ARE ARRANGED BY <br /> CALLING (20?)46&0340L OFFICE HOURS POR APPUINTMBNTS ARE SCNPIIULED MONDAY THPU FIUDAY <br /> EXCLUDING HOLIDAY$, 8:00 Ara To 12!00 NOON AND 1:00 PM TD 4:30 PM. <br /> S. A Puarl c REcoRDs RELEASE AmXATroN (PRRA) Is mquIRED_' <br /> 4. PUSLCi PILaaltWoRDB NOT RETURNED IN TRS 9AMF CONDI 614 AS RECEIVED WILL Be CORABCTED <br /> RY THE'EHD 3tAPP AT 7HH E]LPNiL4E GF 1HB APPLICANT. THIS ADDITTONAL SERVICE WILL S6 BILLED TU THE <br /> AMMANT FOR PATMENT. (SEB EHD POLICY 94-007) <br /> S. ORfoU+AL PUBLic FHXWRECOPM SHALL NOT BE REMovED F" T r,EHD PREMfsm <br /> SIGNATURE OR APPLICANT DATE <br /> SIONATUR&pF RELEASING OFFICIAL DATE <br /> No PHS/BHDRa=b8fflM0 ARE IDEMWT6D: <br /> I\ne fh.nals�rt Nofniewm.OAM <br /> PHS/P.HD RPC-oRbslFiF a g7I{>fp 9N T$R ADDR M(ES) NOTED. YOU 1FIL1 89 NU77lnEb WHiS9 <br /> RISCORDS'AL ES ARE 4YABARLe YoR REvIBW: <br /> �wrc fd.cnw m wn+nc�.a.onr. <br /> TOTAL P.02 <br /> , <br /> V 'i� <br />