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i <br /> I <br /> r <br /> -114'x <br /> 6�-di—l99s3 Iii:iaAti F - TO� 17145a11351 ,P.@i <br /> 5JOA�4 <br /> AN UIN COUNTY <br /> SAN <br /> PUBLIC HEALTH SEkVICES <br /> ENVIRONMENTAL HEALTH D,IIIISTON <br /> PUBLIC RfiC012DS RELEASE APPLICATION � <br /> APP�{ICANT ft�os TE�Zt.�FF sAn►z t'> rr�e <br /> ADDl ESS 90 <br /> AGENCY NAMTs- E PRONE NO <br /> AnDIE5S <br /> tFt'il�♦kf#**x!.***t#'*#*��#'F4#•4##t*ff#*ill*'**t!##ttlf#t#� <br /> USIN <br /> gam, DRSS � F�'3fi_-N � P� OR <br /> A I D LE <br /> , ol <br /> 53 <br /> 4fit� k+t,►t-ltklr#i#4*###'fy'ff##'*4#*#X##*Yl###tkMwil##t*!##Y#ift#R*♦*#w'! tir <br /> THIS}'NOTfrE IS SU9J&CT TO THE REUVREMENTS IDENTIFIED IN THE PUBLIC HEALTH � <br /> SERVMES/ENVIRCINMENTAL HEALTH DIVISION (EHaE POS-ICY #94-007, ORDINANCE CODE Of' j <br /> SAN UOA42Ultu CC)UtjFY. Etio PEE AND SEVi <br /> I4CE CHARGE RESOLUTIONS. STATE WATER CODE, <br /> GOV4RNmEW CL7DE'AND THE E11Li7P.NCE CGDE. <br /> 1. A MAXIMUM OP Tt� L7� PREMISE ADDRESSES RER REl]UEST <br /> 2. PI ELIC FIL9S/R9GOIRD9 REVIEW IS. By API�7tNj_M=MT OBLM A TP10IINN,TME TS ARE MONDAY <br /> EO L3' CALLING {20934$8-3420.`OFFiF HOURS FOR APPOINT EN <br /> THR • FRIOAY EXCLUDING HOLIDAYS, 8.100 AM TO 9 2:U0 NOON AND 1:00 TO 4:30 PM- <br /> 3. A PL)BI.IL; FFLESlFLECORD5 RELPASE APPUCATION IPRRAI IS REQUIRED, <br />` 4. P ELIC FIL SIRECORDS NOT pETURNED 1N THE SAME CONDITION AS RECEIVED WILL BE <br /> COR <:CTEfl BY THS EHD STAFF AT THE ISKPENSE OF THE APPLICANT.• THIS ADDITIONAL. <br /> � PAYMENT. fSEE EH <br /> D POLICY 94- 0071 <br /> NT FOR f' <br /> SERUIICE WIlL BE BIL.LEI7 TO THE APPLtCA � . <br /> 9• i IGINAL PUBLIC PILES/RECURDS SHALL NOT BE REMOVED FROM TNI.EHD PREMISES. <br /> raa�a.a•sa air.. ♦tri.�r..sa.a a.a.♦•ri i4• a. ..a..arrr�r�r• <br /> ay r.%II...ralaarar.�i R� <br /> 51C,I�i1�7UR1+ OF APPLICANT DATE <br /> .. � <br /> SIGN TURF OF RELEASING OFFICIAL pont-11'Fax IMS ' 7671 <br /> EH 00 14 jR& 97481 <br /> i E F22 �►wns <br /> - 7I I��� r�....•r. TLTrr�I. p.91 <br />