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SAN JOAQUIN•COUNTY <br /> PUBLIC ] EALTH SERVICES <br /> ENVIRONN3MTAL HEAL'T'H DIVISION <br /> 1/PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT f�Y r`IytQuC1 �,c PHONE NO <br /> ADDRESS 4M 67 <br /> AGENCY NAME pir-i PHONE NO <br /> ADDRESS <br /> AFL ADDRESS BUSINESS NAME/ PROGRAM OR <br /> FACILITY TYPE OF FILE <br /> Z ►{ C' ..nit �� 9:�� LT <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION (EHD) POLICY 494-007, ORDINANCE CODE OF <br /> SAN JOAQUIN COUNTY,.EHD FEE AND SERVICE CHARGE RESOlUT10NS, STATE WATER CODE, <br /> ' GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1- A MAXIMUM OF TEN 1101 PREMISE ADDRESSES PER REQUEST <br /> 2. PUBLIC FILES/RECORDS REVIEW IS BY APPOINTjI!T ONLY. APPOINTMENTS ARE PROCESS- <br /> ED BY CALLING (209)468-3420. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED MONDAY <br /> THALI FRIDAY EXCLUDING HOLIDAYS, 8:00 AM TO 12:00 NOON AND 1:00 TO 4:30 PM. <br /> "T 3. A PUBLIC FILESIRECORDS RELEASE APPLICATION (PRRA) IS REOMIRED. <br /> j"-a .. <br /> ! 4. PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL.BE BILLED TO THE APPLICANT FOR PAYMENT- (SEE END POLICY 94-007) <br /> 5. ORIGINAL PUBLIC FILESIRECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> .............................r.. ........ ................................ <br /> SIGNATURE OF APPLICANT _ DATE <br /> SIGNATURE OF RELEASING OFFICIAL BATE <br /> EH 00 14 (REV 9/96) <br /> I.w V-11J T A K r Mn7:3n 9lT= &lW Arrr f Wllll J W.BaC-Sr, !FU,,I—47 I I ..e`t <br />