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m <br />f579-2225 <br />MODESTO ATC PAGE 02 <br />SAN JOACUIN COUNTY <br />EUBLIC HEALTH SERVICES <br />1✓NVz9.ONM2r7TAL HEALTH DI -VISION <br />PUBLIC aECOADS RELgAS£ APPLICATION <br />APFI4ICANT �... 4- 6� tcA, PHONE NO <br />A, D� SSS bra <br />A+GOC t NAJAE A HONE ?TO <br />A 0 D 2S'S <br />t*tb,ssw�.e.+bi.r�,ae+.a+•�+•rrlrwwkiM9r#4wit�Yir'rir�rt*t##',k+;�t•rt##yr#stir##ttriyef* <br />itUt,F� A,�33 i3>�ST.A SS rr�El pcn�t�a� C�� <br />FAC rTY mg- GE -F-1 'E <br />4®t till. V�.ri. y •,.c�.s cs.t L.c. �a---r A* Q <br />—. r -k <br />,. ... •, .. .tit: '..,i� <br />i <br />fir+htr#iri►##x4w'xyt�rYrtsrirxxxak'#Rx'm'xt'w'xt�•eyr. A a a sA A A,r•,tx�1•a,e.�tabw.N+YW4rrMtrr►,r,e <br />TI•HISINOTICE 13 SUsjF-4 i IV t I•tt REQUIREMENTS tZENTIFIED IN THE PUBLIC HEALTH <br />S1_RVCE51ENVIRONMENTAl. HEALTH DIVISION (EH01 POLICY x`54-007. Oiif]WANJCE COIDE OF <br />SAN 1OOAQUIN COUNTY, E140 FEE AND SkIdVICk CHARGE RE5CLUTtON9, STATE WATER CG7oE, <br />GOVERINMENT CODE AND THE EVIDENCE CODE. <br />6, A►MAYli4 UM OF IM LM PREMISE ACORESSES PER REQUEST <br />t <br />2. P(JBLIC FILESIRECOfJ05 >4EVtEW IS 8Y —APPOINTMENT -0NLY-'APP`OiNTM-&JTS ARE PROCESS- <br />ED SY CALL(14G 12091468-3420. OFFICE HOURS FCR APPOINTtMENTS ARE SCHE17UL U MONDAY <br />THRU" FRIDAY EXCLUDING HOLIDAYS B•00 A <br />a <br />C4%-+ Q , <br />W <br />W <br />( 1 . M TC 12:04 !Vt)ON AND 1:00 TO 4:30 P <br />3. Aj PtJSLIC FILESlRECORCS RELEASE APPLICATION (PARA) IS REQuittED. 100FIETED <br />4. PUBLIC FILEVRECCIRC}S NOT RETUIINEo IN THE SAKE CCNVDITICN AS RECEIVI=D WILL BE <br />CORRECTED SY THE EHO STAFF AT THE EXPENSE Of THE APPLICANT. THIS ADDITIONAL FEB 10 2000 <br />SERVICE WILL OF BILLED TO THE APPLICANT FOR PAYMENT, ISEE EH© POLICY 84- OQi} <br />i <br />5- t4IC=INAL FUMIC FILESfRECORos $BALL NOT HE REMOVED FROM THE EH❑ PRISES. <br />erg •v•feeaswastragi.w4q*-esse•►aNeaaswMes6•.a!•es rrrswaer ed s�e0yfe�w+raP rrwrw <br />SIGNATURE OF APPLICANT�r�,, 0.4TE Z-��-+ <br />SIG TORE OF )RELEASING OFFICIAL DATE EH Op til (REV 915kj) <br />f <br />TnTAI P. A- <br />