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?49UM,CA 93355 / Faac#` '�3Ea4-0?97 (�ijZcT <br /> C <br /> SAN a'OAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVI1ZC3NMEt4TAL REAI.TH DIVYSTON <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> '>uc�.,-y<-�• PHONE NO <br /> APPLICANT- jt <br /> r�q _ <br /> ADDRESS2I)3-7�1.�+.f__ !�r ! p'raX�ya V40 <br /> AGENCY NAME <br /> ADEDRI;SS <br /> r+tt#ttx4 rr.e*xwa + i-t#*,F*# ,k+ • r a i ►x,h**'i##* + + a ra rxt+#at+•tf f a +e A h • � � • +• - <br /> LJLDRE "S g[rg:zNESS iVAI`}EL �,PO(::tZ1it9 OR � <br /> . TYPE QF FILE <br /> �,2 s-rar 4�.a ti.h1�►� . ..�n4� M:L.4ia�r = ` r y .�22U1: <br /> fl1aZ-Q-11"+� 1`!'F�' i"•_ �`�£h E C'. .�i a-1 ; ~'_ . - 1{ i� ". <br /> J t. <br /> Z - c ►Jt-1� 5 ` fll..zQ77 <br /> * i# t *rret#ew*** ixi*x*#+a '► as � ka:wx-r+rtttw+rw ,it k � a ♦ � k•kk+k+++xaLia k i * <br /> THIS NOTICE 15 SUBJECT TU THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALIII <br /> SERN ONMY DIVISION <br /> !OPOLICY STATE J <br /> C9 CODE OF <br /> 5AIN lOAQUIN COUNTY, FEE AND SERVICE CHARGE RESOLUTIONS. WATER CODS. c <br /> GOVERNMENT CODE AND THE EVIDENCE CGDE. <br /> 1. A MAXIMUM OF TEN (102 PREMISE ADDRESSES PER REQUEST <br /> 7. PUBLIC FILES/RECORDS R VIEW IS BY nvPOINT_ w-r ONLY. ApPOINTMETI')`U AIlL YFcOLESS <br /> ED BY CALLING 1249146$-3420. OFFICE HOURS FOR APPOINTMIwNTS ARI: SCHEDULED MONDAY <br /> THRU FRIDAY EXCLUDING I-1OUDAY5. 9:04 AM TO 12:04 NOON ANI? 1:40 TO 4.30 PM. <br /> 3. A PUBLIC FILESIRECORDS RELEASE APPLICATION IPRRAI IS I;EaUIRED- <br /> 4, PUBLIC FILESiRECOHDS NOT RETURTVEQ IN THE SAME: CONDITION AS RECEIVED WILL BE <br /> IONAL <br /> SERVICE <br /> D1"I' <br /> WILL BE MILLED TO THE f�PPLICAmT OPAY YMErNT. SEE EHO POLICY 9 <br /> 5E:fiVIGE0071 <br /> 5. ORIGINAL PUBLIC FILETS/RECORDS SHALL NOT BE RCMOVED FROM T14E CMD PFIEMIS�t. <br /> ...... ... . ..... . . .............I........ . .... . . <br /> DATE <br /> SIGNATURE OF APPLICANT Pc4- &—•S <br />