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SEP; 2S 'D2 15:46 FP 4 MCLARENMORT ALAMEDA TO 12F 1640139 PAGE.M2. 902 <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HLALTH SERVICAS <br /> ENVllRoNM> 4TAL >3FAirtO DMSION <br /> UBt1C RECORDS RELEASE REQUEST' FORM <br /> 1NDiVIDUALN SP � PHO14ENO 5,o •-7YB SGzb <br /> ADDRESS Wbt5 AvQ <br /> AGENCY NAME <br /> PHONE NO s/o sZlzdb <br /> ADDRESS <br /> FILE AD12R 1= amacEM 1 D= <br /> AGENCY am <br /> H• •OS LS ("�� r'L $!bCl<7P�-! S/rN -).'�h•.4+IN COJ -I.TY I � )'Z. <br /> San Joaquin County Pu ik Health Services FhvirogartAtal Health Mvision Ata at considered public records <br /> except for aittle doet mteftU tdenthW in the Oovemnm( Code and the Sure WOW Code. <br /> Requestt for public fee 9d9 or Me revi"A are subject to chat go established In Sen Joaquin County Iluka and <br /> ReguloWn Envirvame atal Health Permit Feet slid SetvMom Charges. <br /> Charter for remrdt or documents requested by Subpoena duodt tecum are subject to chi" eslab�hhed In <br /> the Evidence Code. <br /> Pboto ooples of public documents are subject to Public Rwjc4 policy #91-00I. <br /> SIGNATURE OF EQUESTINGPARTY DATE <br /> SIGNATURE OF 1ELEASINO OFFICIAL DATE <br /> EI1 00 14 (REV 191) <br /> 1 t d os =sl Z6iiZ/60 woaA <br />