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SAN JOAQUIN coumv <br />PUBLIC 11FALTtf SV-RVIC95 <br />'ENVIRONMENTAL HEALTH DIVISION <br />PUBLIC RECORDS kELRASE REQUEST FORM <br />INDIVIDUAL NAME Stew[Z' 4K LE PHONE NO <br />ADDRESS e - !-y 0,0 LA-tzyt , uI 7 3L- q Z <br />AGENCY NAME TWt. H i hel PHONE NC <br />ADDRESS Z'C'2- -7 •. -- <br />FILE ADDRESS <br />U u ` La LIA VV <br />C04f �,,Y <br />I L kl 1�21m,y C N <br />U 5(r Ciao <br />I `f33—nil <br />�e ltwu <br />L.-io lqul <br />�(�r�1 <br />Tic �' lcr.�,� 5 <br />O� D� '� <br />0�0 nu.CF-s <br />I Ho S FYtSn o <br />lrt BYoS� <br />I�� <br />. <br />r �n 1 <br />I loY t w <br />tcw f,c,r <br />�a��N u.l.�ollncll� <br />zc�cJ <br />W• �I.�WFc.r <br />PUL <br />1 Q DN <br />Lr c� �Lo�m <br />7�-(I <br />NaU <br />91 MgTU w IN <br />;s <br />r [� I L7 <br />te 31 Drs 41 <br />Ar:�IbTSe- <br />l.ocIAL <br />QR i u&T <br />lio LSC <br />L,c e a,( <br />K3ICT-r <br />Lo c t� <br />D15 � <br />L(tT ) <br />3z�t <br />DATE OF <br />REQUEST <br />San Joaquin County Public Health Set0ces Envitonmental Health Dlvislon flles ere considered public records <br />except for certain documents Identified In the t:lovetitmeni Code and the Siete Water Code. <br />Requests for public records or Ale reviea►s ere subject to charges established In San Joaquin County flutes and <br />Regulation Environmental Health Permit tees end SeMces 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 Records Policy #91,-Oul. <br />SIGNATURE OF REQUESTING PARTY DATE I I S��Z <br />SIGNATURE OF RELEASINO OFFICIAL DATE <br />EH 00 14 (REV 3/9]) <br />90 � <br />