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Ell UO 14 (lu,V 5/94,..- SAN ,JOAQUIN COUNTY <br /> PUBLIC 11EALTII SERVICES <br /> ENVIRONMENTAL HEALT11 DIVISION <br /> vunLIC RECORDS RELEASE APPLICATION <br /> APPLICANT - e, &hij icin PHONE <br /> ADDRESS <br /> AGENCY NAME P1E1,0NE NO <br /> ADDR&SS Z l.S <br /> i <br /> j3L�AULEAD AfrENCY DATE <br /> • rfzq c�qn C3�re,✓ _ .�S.�G a25/0T' - rY1 o(`s(,Z>' L � 'e2�t' /(_7,�� 7 r 7-'rz <br /> S-g J <br /> l Do IV a o �t[c lit,! ("QA}fir l..r �rs1_ t <br /> 7 15 0 Af -4— r,l c A G140'A., U <br /> -- I <br /> 11115 NemCE IS SUN1FCi' TO -ni - REQUIREMENTS IDENTIFIED IN Tun PUBLIC HEALTH <br /> SERVICr.S/E14VIRONMENTAI.HEALTH DIVISION([IND)POLICY#94-007, ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, E-HD FEIiS AND SERVICE 04ARGF. RESOLUTIONS, STATE WATCR iCODE- <br /> GOVFRNMENT CODC AND THE EVIDENCE CODE <br /> 1. A MAXIMUM OF TEN(10)PRr,.MtSR ADDIMS363 PER REQUEST. <br /> I I <br /> 2. !~ISRLIr. FIE.F.S/R1rCORDSAEVIEW Is 8Y ['I'OINTM - ONLY. ApPO1NT11IFNTS ARR ARRAN. BY <br /> CALIANC (209)468-0340. OFFICE mucta FOR APPOINT aN TS ARE SCHF-DULm MONDAY TURU I!FRIDAY <br /> EXCLUDING HOLIDAYS, 8:00 AM To 17.:OU NOON AND 1:00 f'M 7b 4:30 PM. <br /> 3. A PUBUC RSCORw RaxAse AL'PL.ICAT1oN(PARA) Is RzqutRED. <br /> 4. PUBLIC FILES/RECORDS Nar R13TURNGD IN'TIL6!;AMR co"DITION AS RSCEIVEt) WILL 89 CORRECf6D <br /> t%Y 'PILE EHD STAFF AT THL3 6XPUISS OF TNR APPLW-ANT. THIS ADDITIONAL.SERVICE WILL R$ BELLED TO TYLE <br /> APPLICANT FOR PAYMENT. (SER MID pOi.;cy 94-007) <br /> 5. ORKItNAL PUQLIC FIL1r,S/RECURDS SHALL NOT 8£ R£MOV$L7 FROM THP. E1I11 YILEMISFS. <br /> SIGNATURE OF APPLICANT - DATE <br /> SIGNATURE OF REZCASING OPnCIAL ' DATE <br /> NO P1iS/EIiE) Rr-.coRDs/FILES AR9 IDENTIFIED: <br /> D++.+ b.ws�n Mervwxnaa.Ian tt: <br /> PHS/Elab Rt:CoRl7s/E'Li.&4 Fxtsr aN TIIB ADDRER4($S)IVO'I'L3D. YOU WILL BB NOTIFIED W11BN <br /> RT,CORDS/FILI:..S ARF AVAILABLE FOR REVIEW` <br /> nam terws n: t�n�Gnnw f�,t <br />