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SAN JOAQUIN CO ',%0 !µG <br /> PUBLIC HFALTS SERVICES hs7 trt2u� , <br /> ENVIRONMMNTAL EMkLTH DIVISION 3v <br /> PUBLIC RECORDS RELEASE REQUEST FORM <br /> f <br /> IND IVIDUAL NAME .S-Ar'}'!u.ell PkL L 0HQV40 PHONE NO ZL2 q 3I_0g 4a <br /> ADDRESS Oo <br /> AGENCY NAME e2/l �0S PHONE NO <br /> ADDRESS <br /> FILE ADDRESS LEAD ENFORCEMENT DATE OF t <br /> AGENCY REQUEST <br /> ?900 <br /> /c6- -/70 <br /> amenoa Ilies are oorstdere I public 77-- <br /> except for rtaia documents identified in the Government Code and the State Water Code_ <br /> Requests for public records or file reviews are subject to charges established in San Joaquin County Rules and <br /> Regulation Environmental Health Permit Fes and Services Charges. <br /> .Charges for records or documents requested by subpoena duces tecum are subject to changes established in <br /> the Evidence Code. <br /> Photo copies of public documents are subject to Public rds "cy #9 I. <br /> 1,7 <br /> ZPARIC DATE �'Sr <br /> SIGNATURE OF RELEASING OFFICIAL DAA <br /> EH 00 14 (REV 3191) <br />