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i - <br /> tt <br /> LII VU 14 (ItI;V 5/94) SAN ,IOAt1UIN COUNTY9 A24 � <br /> PU111,1C HEALTH SERVICES <br /> ENVIRONMENTAL HE W;111 DIVISION 4, <br /> I'UI1IAC RECORDS RELEASE APPLICATION <br /> APPLICANTsJ�o w4„ `�- ,<�/� PHONE NO—Z 6'y 3 YT <br /> ADDRESS <br /> i1GENCY NAME 1'/'c lZ un ct /mssD c/,--I-W3 PRONE NO <br /> ADDRESS L I C dc-zl k S-) -F't <br /> DILE ADDRESS LEAD ,AGENCY DAT1= <br /> -�qsz;? 'n r c-i/ t�4✓'n I Cr -- n 3 d -� C//)R un <br /> �? L� Yx N E / ao(-Zw coo CSA �.� /,�, ��� i-c•,-- <br /> �i 1k1/nf 1,-rel � /-mer <br /> Zc,v <br /> �`lX �✓ �IBt��n. K�U�, C.O� � /mac it � � <br /> THIS NOTICE 1S SUBJECT 3.0 Till's ItE-QUiREMENTS iDEN-11FIED IN TI-IE PUBLIC HEAL'i-14 <br /> SU,RVICI',S/ENVIitONMIiN'I'AL IiGAI:I.11 DIVISION ((IIID) POLICY t/94-007, ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, Elli) 1--El-;S AND SERVICE CHARGE RBOLU-11ONS, STATE WA'I'-it CODE, <br /> Gov ERNMENT CODE AND'111E UMDENCE CUDi's. <br /> 1. A MAXIMUM OF-rr-N (10) PREMISE ADDRLsscs rm Rc-Qur.S'r. <br /> 2. PuBLic FiLES/RECORDS REVIEW is BY A1'I'OIN'I*MLN'I'ONLY. AI'ro1NTn+cNTS ARE ARRANGED BY <br /> CALLING (209)468-0340. Or•FicE IIOURS FOR APi'OIN-i-MENTS ARE SCIIEDULED MONDAY TIiRU FRIDAY <br /> E-XCLUDING HOLIDAYS, 8:00 AM TO 12:00 NOON AND 1:00 PM -ro 4:30 PM. <br /> 3. A I'UIILIC RECORDS RELEASE APPLICATION (I'RRA) IS REQUIRED. <br /> 4. T'unLIC T'1LLS/RECORDS NOT RrrURNED IN TILE SAME CONDrrION AS RECEIVED WILL BE CORRI:CTIiI) <br /> BY THE E1-ID STAFF AT THE EXPENSE OF THE APPLICANT. TiIIS ADDITIONAL SERVICE WILL BE BILLED TO THE <br /> APPLICAmr FOR PAYMENT. (SEE E(ID POLICY 94-007) <br /> 5. ORIGINAL PUBLIC FiLM/RECORDS SHALL NOT BE REMOVED FROM THE EMD PREMISES. <br /> SIGNATURE- Of AP!'LTCAN"r -'' DATE <br /> SIGNA'T'URE OF RELEASING OFFICIAL DATE <br /> No I'I•IS/EIID IIECORDS/FILES ARE IDENTIFIED: <br /> nA1nt Rmanwen tIT2 ,q..r R.A170N t)A�n: <br /> PIIS/EI-TD RECORDS/FILES EXIST ON TiiE ADDRESS(ES) NOTED. YOU WILL BE NOTIFIED WHEN <br /> 11rcoRlls/1'II,E.S ARF AVAILABLE FOR REVIEW: <br /> nA/nc Rnvmwm RTS Mmrtm" N nAint <br />