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F7 173 <br /> SAN JOAQUIN COUNiY <br /> PUBLIC HEALTH SERVICES <br /> EVVITZOUMENTAL HEALTH D.LVISION <br /> PUBLIC RECORDS RELEASE APPLIC41TION <br /> npFr�zCnrrr / .GLc>✓c4 Y�!S PHONE rdU–l�iJti�'/�xi-�3CrC? <br /> t�(�t)Izr,�s � �—oGJ�11i 5 iJv /tN7L+n� l </ �f – <br /> IlG _P110NE NO_(�!!� <br /> ADDRESS -----._... -- ------ <br /> y r ri a••�*♦+t**! /. A A k k•w***t t k** �•-k#'ilr+kkt ** k# i'•4'!'�`►i i ♦A i #w kY**+ <br /> BUS A'rS:; OAME1 PRn RAM OR <br /> FUI,,L ADDR,,Sa. 11YYE OF FILE <br /> E 1\C I I urT <br /> fti'f!3 tStavc ,c� �- `-- ' �.�t _ 'or7 ����i�rtF1L ��-�'r e. Cr•�_�'Jc.'yti�lt� <br /> -usr <br /> 2�0 1�3lLt�ia► 41r k�a��'► ��r �sca.v�ylc _ – <br /> �1 ACJ¢c_`" Y.,�f�_ � +� o � yN!' ✓�GeS �.� ss X11 r <br /> a_ry <br /> 15 <br /> C. �e Crenc�3t <br /> ' ✓ Let ++ J� !'� f c1��'l T►�,t.�---- c! C�_5L1y – <br /> 1_a.L�--- <br /> ;tyKa_T <br /> ,fi r##*k +tkstwlr+b,►witiFk#*t * # { ,� 1 k !'k k f* k t ii•*{r*#'#''�•*•�'�t�rt,t-k4,-k <br /> 'I'l Its Nol'ICF IS SUBJECT TO THE RCQUInEMENT S IDENTifim IN THE PUBLIC HEALTH <br /> SERVICFSJEidVIR(,jr4NIENTAI_l ICALTH DIvt51ON 1EH01 POLICY #94-047, ORDINANCE CODE OF <br /> SAtI .JOACIU(N COUNTY, FHt7 FF5 AND SERVICE" CI1AnGE RESOLUTIONS. STATE WATFR CODE, <br /> G(')VERNMENT CQDE AND THE EvlDENCE CODE. <br /> 1 . A MAXIMUM (7F t�fV ('I()) PFIEMISF ADORPfiScS PER Rrzout- 1 <br /> 7.. PUBLICFtt_FS/HEC(�R1�`+ IlEV1F_\n, IS BY APPOINTMENT OhILY. APPOINTMENTS ARE PROCESS- <br /> Fh RY {:,ti f tNC; 17.0'1l�IFII 3�Zt3. OfF1CF 1 iC?lft2S FOR APPOINTMENTS APE Sr -) MOPIDAY <br /> THRV FRIDAY FxCLUOING HOLIDAYS, 3:00 AM 'f0 12:00 PJOON AND 1:00 TO �t:30 rM_ <br /> 3. A P1?I-t1_!C: FiLE5/RF(-0FtL'y RF_LEAS1- APPLICATION (PRRA) IS REQUInED. <br /> 4. PUBLIC FILESiPF!,0(lt'), NOT Rf_ 1)(ZNED IM lilt ;ANII: CONDITION AS RECEI\fl'a WII.L. BE <br /> (,()KHi-CTE-D BY THE EF-fn STAFF AT THE FXPFNS>: (7F TI•IF Arill.ICAN 1' i 1115 ADDITICIPJAl, <br /> SFRVICF 16/11.1- nF BILLED tU I FIF APPLICAN f fQR PAYMENT. (SFE FHD POLICY 94 007) <br /> ,. ORIGINAf_ FUi't_IC FIL[5'�ifCt?Rt`. 'HALL MI)T F3F REMOVED FROM TIT a10 PnEWSES. <br /> . . . .. . . . .. . . ... .... . .. . ... .. . ... ... . : ..... . . .. . ... .... ............ . . ......... <br /> SIc, JA f URF OF A.FPl_.ICA(JT {z��4:� •�jt1��---.-- DATE_S_1-tI'I <br /> SIGNATURE nF- RFI IFA SING OFFICIAL_ !DATE –_ <br /> 1-1-4 00 14 mem 9i961 <br />