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SAN JOAQUIN COUNTY I �y -Isj <br /> PUBLIC HEALTH SERVICE <br /> S� <br /> ENVIRONMENTAL HEALTH DIVISION 3 v <br /> PUBLIC RECORDS RELEASE REQUEST FORM <br /> INDIVIDUALNAME' rnaS -T `/a �C-�N PHONE NO <br /> ADDRESS 1 t2 -�-e LIe3 , <br /> AGENCY NAME 'v Co PHONE NO SaY-, , <br /> ADDRESS <br /> C {� <br /> FILE ADDRESS Q IN ht S LEAD ENFORCEMENT DATE OF <br /> AGENCY REQUEST <br /> Z22 �J. El ao S+ C\iRu)QCL' silt' cr & C)iL% <br /> HUP 1-oP ile cc�dte �h Si 3s35-17� r �e <br /> �orAQ : ZOtnS ��-�:..7�, 35 <br /> L_Q_Z_ N . iv. rot4-. St- URt,AfT); S'Ihotb o-. 9 S�y -t9.Ea <br /> S E H I1ST '. S i{f trAo : 116345 <br /> lilt f �J- van lam- MnS <br /> tl tel , �Jel�r Sfi (Z 1�1CR'. St� C�r4fl'. <br /> F.h W , Wtzl�vr C� fMaal s IeCN4o ' 9 t .Ge mow; <br /> I <br /> San Joaquin County Public Health Services Environmental Health Division files are considered public records <br /> except for certain documents identified in the Government Code and the State Water Code. <br /> Requests for public records or file reviews are subject to charges established in San Joaquin County Rules and <br /> Regulation Environmental Health Permit Fees and Services Charges. <br /> Charges for records or documents requested by subpoena duces tecum are subject to changes established in <br /> the Evidence Code. <br /> Photo copies of public documents are subject to Public Records Policy #91-001. <br /> SIGNATURE OF REQUESTING PARTY DATE 'Z 9S <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 3191) <br />