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I- u1 <br /> Ll 3 <br /> MSK. S�1uia. <br /> SAN JOAQUIN COUNTY <br /> P9LIC RZALTH SnVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> pTjSLIC RECORDS RELEASE APPLICATION <br /> APPLzCANT SAtv4 0 av-e PHONE NO_n 1L qq4-0i2.3 _ <br /> ADDF�ESS ramft acvti►� y++e 4 <br /> pG cy ppMg PHONE NO QI Q� 1Z <br /> ADDRESS_ �.,.��A abs-.c _ .�.... <br /> lfair,t,r*#w# t*###f+k+kir*yrtr*+*#►tiFt**+rrilrvf�tirlrttiilr�rartt#!***f1►�tk�rt**t** <br /> ADDRESS SUSIITt>; �RO[31itAM OH <br /> FACILITYTYaZ O L$ <br /> i <br /> osM. _A Aroc4L493 _ LvST <br /> 1-u N.EI Dorado t�1e��r_ + rfr�sri � ,I LUST_ 35 [� t�►I <br /> 1310 : 0. S1DrraA P _ Cegyd �o►r' Ti ra. j.-wF�V ST <br /> Amer. —Lj— A—fC t-.V<F 25 4,0 <br /> ttftf�tttAf#ttftf##�ti+!litl�tFtilrt*tlrlr+***#tlt�f*yr+t#tt#tt**#�Ytl9rfttft3 <br /> THIS 0T10E IS SuaacT To TmE REQUIREMENTS IDENTHRED IN THE PUBIJC HEALTH <br /> SERVIIM"ANVJRONMENTAL HEALTH DIVISION 4EHD1 POLICY #94-007, ORDINANCE CODE OF <br /> SAN JOAQUIN COUNTY, EH©FEE AND SERVICE CHARGE RESOLUTION$, STATS WATER CODE, <br /> GOV&NMENT CODE AND THE EVIDENCE CODE. <br /> 1. A MAXIMUM OF 3M=PREMISE ADDRESSES PER REaVEST <br /> 2. PUBLIC FILESIRECORDS REVIEW IS BY,EPOS ONLY. APPOINTMENTS ARE PROCESS- <br /> ED BY!CALLING I.208MMI-M20.OFMCE HOURS FOR APP011 mENTS ARE SCHEDULED MONDAY <br /> THRU ORIDAY EXCLU04NG HOLIDAYS, 8.00 AM TO 12:Oq NOOK AND 1:00 TO 4:30 PM. <br /> 3. A jUSLIC r:IL>ESIFIECORDS RELEASE APPLICATION JPARAI a MMREO. <br /> 4. PUBLIC FILE" CORDS NOT RETURNED IN THE SAME CONDITION AS REClE:rvW WILL BE <br /> CORRECTED BY THE ZWD STAFF AT THE t0XMfE OF THE APIPUCANT. THIS ADDITIONAL <br /> SERVICE WRL BE BILLED TO THE APPLICANT FOR PAYMENT. I3EF RHO POLICY 94-0071 <br /> 6, ORtiGINAU. PUBLIC RLES/RECORM SHALL NOT BE REMOVED FRONT YHE Em PRIMISES. <br /> ••+•fj�a••a•„�+;•;a•a.��a ••••a•f�A��•••fMi• <br /> 010 a.04P••���••.•3♦♦i+fr•a•••♦moo <br /> SIGNATI3RE OI=APFUCANT DATE 913a l-91'l <br /> — • <br /> SIG OF RELEASING 0FIc1CIAL DATLO <br /> EH 00114 IREV 81961 <br /> I I <br /> TOTAL P.01 <br />