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11v13 '95 16=57 IMTE FAX:209-551-3593 PPGE 2 <br /> SAN JOAQUIN COUNTY a FbX (aoR) 4(a4-413a <br /> PUBLIC MMLTH SERVICES <br /> ENVIRONMENTAL Up <br /> ALTH DMS,I®N U"2Z--5- <br /> PUBLIC RECORDS REjrAsE REQUEST FORM 3 <br /> L"VI MUALNAME <br /> ADDRESS Px J NE NO <br /> AGENCY NAME <br /> ADDRESS rpil1ONE No <br /> FILT✓ ��tFSS <br /> ,fit 1 G r-CS are fc civL ce r ,ri <br /> s � r <br /> San loagaint County Public Health Services <br /> excepc for dxttaltt documents iddsntllied In F,.nv'vowfenta!Health Dlviaiun 6f1es are considered public records <br /> the feveMment Cade tmd the State Water Cade. <br /> Requests far public reaards or file reviews are subject to dwgcs <br /> Regulation Envestabilshed in San Joaquin County Rules ansd <br /> icoraanentat Health Permit Fees and Servicq Charges. <br /> Charges for records or documents requestcd by subpaetta doves ted M are subject to cbangcs estabUsltcd in <br /> the Evidence Mode, <br /> Photo oopuz of public documents are subject to Public Records Policy#91-001. <br /> SIGNATURE OF REQUESTING PARTY DATE 6 <br /> SIGNATURE OFRELEASING OFFICIAL <br /> DATE <br /> EH 00 14 (REV 3/91) <br /> i <br />