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Uo Lu 1JJ1 _•.,••.,Gr-ter r ..v.r ra ..�..... .r ..�,. _.._. <br /> Ta y � /UAn <br /> Fane#� �Y/t�'�3�25" F'`�e 9Rr n-'jpttc Z2G0 <br /> Far � F g��`�� Y� -ZZZZ _ r <br /> ---. - ----UIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONKENTAL HRALTR DIVISION <br /> PLIC RECORDS RELEASE APPLICATION ,t <br /> APPLICANT PHONE. 1N0 _CI��`1- -z-z400 <br /> ADDRESS <br /> AGENCY NAME Kr—az a.m tea. r,rs �c PHONE NO <br /> ADDRESS <br /> F'U�L ADDRESS BUSINESS NAME/ PROGRAMER <br /> .FACILITY TYRA OF FILE <br /> Io1� rnr3n i _ L s <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION IEHDI POLICY #94-007, ORDINANCE CODE OF <br /> SAN JOAQUIN COUNTY, EHD FEE AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. - <br /> 1. A MAXIMUM OF 1, FN PREMISE ADDRESSES PER REQUEST <br /> 2. PUBLIC FILESIRECORDS REVIEW IS BY APPOINTMENT ONLY. APPOINTMENTS ARE PROCESS- <br /> ED BY CALLING I20SK68-342(1. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED MONDAY <br /> THRU FRIDAY EXCLUDING HOLIDAYS, 8:00 AM TO 12:OQ NOON AND 1:00 TO 4:30 PM. <br /> 3. A PUBLIC FILESIRECORDS RELEASE APPLICATION lPRRA) IS REQUIRED. <br /> 4. PUBLIC FILESIRECORDS NOT RETURNED IN THE SAME CONDITION As RECEIVED WILL BE <br /> CORRECTED BY THE EHO STAFF AT THE EXPENSE OF THE APPLICANT. THIS At7UtTIONAL <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 /> •af isi#is.Ab•Iiiib•'ii.�Alyiib.D#ai6•s#'•4#wsibb ME a#i#t®i#•4#'••iA'tr•s.pis•ii®i.i• <br /> SIGNATURE OF APPLICANT - DATE <br /> SIGNATURE OF RELEASING OFFICIAL VA <br /> DATE <br /> EH 00 14 (REV 9196) <br /> TOTAL P-01 <br />