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SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICESl <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT \3an147-ff*nl A/lKLo rt/C PHONE NO "115 yS 7-M Z f <br /> ADDRESS- <br /> AGENCY NAME PHONE ND <br /> ADDRES'S �I <br /> FULL ADDRESS BUSINESS NAME/ ! PROGRAM OR- - <br /> FACILITY TYPE OF FILE <br /> ffSk& UL �. <br />{ II <br /> 'p <br /> i <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION (EHD} POLICY I194�007, ORDINANCE CODE OF <br /> SAN JOA'QUIN COUNTY, EHD FEE AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. 11 9 <br /> 1. A MAXIMUM OF TEN u PREMISE ADDRESSES PER REQUEST <br /> 2. PUBLIC FILESIRECORDS REVIEW IS BY APPOINTMENT ONLY. APPOINTMENTS ARE PROCESS- <br /> ED BY CALLING 1209}468-3420. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED MONDAY f <br /> THRU FRIDAY EXCLUDING HOLIDAYS, 8:00 AM TO 12:00 NOON AND 1:00 TO 4:30 PM. f <br /> 3. A PUBLIC FILES/RECORDS RELEASE APPLICATION IPRRA) IS REQUIRED. <br /> t i� �N <br /> 4 <br /> 4. PUBLIC FILESIRECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. (SEE EHD POLICY 94- 007) <br /> 5. ORIGINAL PUBLIC FILESIRECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES: <br /> SIGNATURE OF APPLICANT DATE A ZG 9-G <br /> SIGNATURE OF RELEASIN FFICIALI DATE <br /> EH 00 14`(REV 9/96) ! <br /> Ik � <br />