Laserfiche WebLink
u 99- 152 <br /> i <br /> SAN JOAQUZN COUNT'! <br /> PUBLIC HEALTS SERVI�.S <br /> EIdVIRON�tp,,n'u, K�,T-� pIVISICN <br /> F <br /> PUBLIC RECORDS R-ELZASE APPLIC Arjor; <br /> ACDRESS F J PfiCtiE Yd `f- <br /> OY iI �(v '.od �.¢ ql-z / <br /> AGENCY NAMg.�rr�mow,.I./ SG face S� „vs PHONE No Z05---TT— <br /> ADDRESS <br /> �3J- . 7 <br /> I <br /> rr.4fiYliyttttXXtttfttfttfXxttttttttttt'tttt'tXYt Ttt ltXftXf ttt=*t'tf j <br /> FULL ADDRESS BUSINESS NAME_ <br /> aclLIOR <br /> Z — <br /> i <br /> I h R <br /> . f <br /> -------------- <br /> t'XXP�#�.#y Y•J tXXX•r1t if tltf tXX♦iX♦fft.�� <br /> #XTi ttY♦it►t't'1'* IF* It t.v', <br /> T--HIS V.QTFCE 1S SUS:ECT- Q THE REauln-AENTS IDENnFIED Hu THE" PIJBL�C.4EALTH <br /> SEEN1C:S1EN V IROMM 4 <br /> E'D[t�l.4EALTH ptVt5101v rEl-tOi PwJUCf #9Q-Q07. QRDIMANCE CODE ::F • <br /> SAN JOAQLJNN CJC;NTY,EiD FEE AND Scc-RVIC:CIrAAGE 4ESDu�TtOtu c <br /> GOVERNMENT CODE AND THE EVIDENCE CODE S STA�c WATER COQE, <br /> t. A SAAXIMUM OFi D;L0 PREMISE ADDRESSES PER REQUEST <br /> Z. PV6L.JC RLESIRECOROS REVIEW 1S 9Y QPF�IRITME;AIT o AP. <br /> FQ �' LLtNG (209)46g.342q; OFFICE HOURS FOR APP(;ONLY. <br /> OINT1btE1tiT5 ARE PROCSS- <br /> THRU FRIDAY E-XCLUDIUG HOI JOAYS, 8-00 AM TO 1200 QQ gNDARE <br /> E CED ESD MONDAY <br /> 3. A PUBLIC FLES'RECORDS R <br /> ft.-ASt aPf'UCATION 1PRRJ11 lS RFQl1tRp- <br /> a. PUBLIC FiL!SIRFCORDS NOT RETURNED 1N TWE SAME C <br /> CORRF_CTED 8Y T4f 'EHD STAFF AT THE ONDITION AS RECEIVED WILL SE <br /> SERVICEvs/t gf g�� TO THE E7CPl�tSE OF THE APP(J TiJIS ALICIT70NAL t <br /> APPLICANT FOR PAYMENT. iSEE EHO POLICY 34-007) S <br /> i <br /> 5. ORIGINAL <br /> PUBLIC Fgc <br /> -SMECORDS SHALL.Nd REi"OVED FROVA THE EIiD PREMISES. <br /> ...................... <br /> SIGNATURE OFAPPUCANT <br /> ••� ^. <br /> DATE.................. r.. .� .. ! <br /> /7��; # <br /> SFGNATURE OF REISASU,#G CFFIC7AI. i <br /> EH 00 14 Rol 9196# CATE i <br /> i <br /> TOTAL P.a <br /> � '� ="" SS - I unr <br />