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08/28/95 14:14 0510--+35 5368 BN1ZtIZ INC. <br /> ...�-.^" GCI-cv-lJxl GC.•'IOM�'1 r 002/002 <br /> To 15109r--1 i B P-02 <br /> Ell 00 14 (REV 5194) SAN JOAQUIN COCINTY ���t 5-117 <br /> PUBLIC HEALTH SERVICES <br /> MOMWMTAL nEALTH D"iorr 3 Li <br /> PUBLIC RECORDS RELEASE APPI1'CATI0N <br /> ApPIsc.4rn- MC A//; e-/VMlX -rllC. PHC N0�.5ta}q35-4gay <br /> ADDRESS nau ) Lrr GValn Uf Cret!✓ CA 9`/`59 <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> F—LEAPPIRM AGIIVCY <br /> Knepp 1;-, l-- DATE <br /> 555 N Mai►+ --S+ /4m44MQ (;4 Q533(,, <br /> a Ro QIxk',s 5L-510 N Main Sf, Marl A 9533(fl <br /> bmb-,-n Cltrners TnG—600 m-Main St 1�l� 95336 <br /> o BMMA #3— — 74 <br /> Sort D <br /> THIS NOTICE 13 SUBJECT TO THE REQUIREMBNTS IDENTIFIED IN � UC NFA <br /> SERVICEWF-MVIRONMMTALI'IBALTH DIVISION(EHD)POLICY 994-007,IN <br /> c d89f OF SAN <br /> JOAQUIN COUNTY, EMD FESS AND SERVICE CHARaIS RwoLUTjMjr0, �TE 1uATER CODE, <br /> GOVERNMENT CODE AND THS EVIDENCE CODE PER EiVTgL�FIEqLTH <br /> M!T/SER� <br /> L• A MAxmtUM OF.Tri" (I0)MISMISS ADVAMES PER R6Querr. CES <br /> 2. 1PU$Lic FII EMMCORDS REVEEW is sr APPOIHTI1NEId'I'ONLY. AFPOIMMF.NT&ARE ARRANGRO BY <br /> CALLING ('209)469-0310. OPME HOURS FOft APfO1NIMaKM ARE SCHEDULED MONDAY THRU FRIDAY <br /> EXCLUDING HOLIDAYS, 8:00 AM To 1200 NOON AND 1:00 PM To 4.30 pM. <br /> 3. A PURUC RECORM RM-SJOE APFLICATIoN (PRRA)IS ItUgUIRED. <br /> 4. PUBLIC FILESJRE+Q0IZD4 Nor RETUA"W 1iV -nits sAILIS COMIT10N As REMWISO W AL as ComaC -60 <br /> BY THE EHD STAFF AT 7H8 E u m OF THr,APPLICAIrL T1113 ADDITIONAL SMVICE WILL firs I t r Ep TO Tart <br /> "PUCAMT FOR PAYMENT. (SEE MID POLICY%4)07) <br /> 5- OIUGHaAL PUBuc FIIZSMECORDS SHALL NoT BR RBMOvSDFROM T1I8 MD PIttmFsEs. <br /> SIGNATURE OF APPUCANT DATE <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> El <br /> NS/E"D REcoRDa/FILts ARE IDENTIFIED¢ <br /> �b�a�aaow ogre <br /> RFiCORD&TIL 3 EXIST ON THE ADDREM(ES)NO[EXfYOU WILL BB MOtiFL D WUSN <br /> PIL�4 ARE ATMLARLB FOR RRvlglp <br /> �w...,v s.i nsrs.a�na�darn, • <br /> REQ <br /> 9/�g/9s <br />