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• i <br /> SAN JO,AQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT Pc'"7E� - 'MeQE PHONE NO <br /> ADDRESS �Z� l_P.cinnA. ,ao Ga�oc.:It CA <br /> C AGENCY NAME PHONE NO <br /> ADDRESS <br /> FULL AUllRJ✓SS BUSTNCSS NAME FROGR.AM OR <br /> _FACILITY TYPE OF FILE <br /> SC-2 t'4 . C <br /> 33aT 3c;,p <br /> \ t.3 �rt1�1N. nnly►�c mIi C N �\ 'T �1% �� c` <br /> ,c ����A C clf�Q"Y�2 LCA C tcJ:.;c 1a M�wi FiZ to c.N <br /> 4� MA�il�c�A <br /> :� \'�j0 N �J A t� AU M -Y 'C.C.:L NC, `Cpc,•,�� �-`.: rarnt i:] 'Ct '-��- ,: <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICESIENVIRONMENTAL HEALTH DIVISION IEHD) POLICY X94-007, ORDINANCE CODE OF <br /> SAN JOAOUIN COUNTY, EHD FEE AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1 . A MAXIMUM OF TEN L O! PREMISE ADDRESSES PER REQUEST <br /> 2. PUBLIC FILES/RECORDS REVIEW IS BY APPOINTMENT ONLY. APPOINTMENTS ARE PROCESS- <br /> ED BY CALLING 12091468-3420. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED MONDAY <br /> THRU FRIDAY EXCLUDING HOLIDAYS, 8:00 AM TO 12:00 NOON AND 1:00 TO 4:30 PM. <br /> 3. A PUBLIC FILES/RECORDS RELEASE APPLICATION (PRRA) IS REGLIMED. <br /> 4, PUBLIC FILES/RECORDS NOT RETURNED 1N THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICF WILL BE BILLED TO THE APPLICANT FOR PAYMENT. ISEE EHD POLICY 94- 007) <br /> 5. ORIGINAL PUBLIC FILESIRECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> • • • • + + a+ •s s+++s s i•+ ►s+ ++ + +s a+ a a•+•r s s r ++a a++++ a♦+s+ ♦ +•♦++a a a t a a ++a <br /> SIGNATURE OF APPLICANTDATE <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 91961 <br />