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SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL, HEALTH DIVISION <br /> / PUE IC RECORDS RELEASE APPLICATION <br /> APPIICANT�{W KL %�-NoC li 6 5 PHONE No <br /> ADDRESS / 8� rQlnt/^e rpt , S _q r <br /> AGENCY NAME_ No�7r/ovp,t C I✓i,2o .v PHONE NO 5- <br /> ADDRESS <br /> $ D LEAD AGENCY DATE <br /> )oQ7f( Sflnl EH <br /> �ve <br /> Adrorc6� (o /� ESi FR��YlGW7 T ELl <br /> 13 57a F,yin A„><r. CH./9T3�c. <br /> k� <br /> /6,o. /R tF8 met n 2 �' <br /> PAYMENT <br /> — <br /> EG <br /> NOV <br /> �s�"tOq INCOUN f <br /> ?UB01M"A, HEALTH DIVISION <br /> (1N1� .� <br /> TMS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE;"UC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION(EHD)P011CY A92-007,ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, MD FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1. A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILESMECORDS REVIEW ARE BY AFPOTNTMENTlg=. ,APPOi1�ThfENTB ARE <br /> ARRANGED BY CALLING (209)468-0340. OFFICE HOURS FOR APPOQV'T'MENTS ARE SCHEDULED <br /> MONDAY IMU FRIDAY EKCLUD1NG HOLIDAYS,8:00 A.M. TO 12:00 NOON AND 1:00 P.M. TO 4:30 <br /> P.M. <br /> 3. A PUBLIC RECORDS RELEASE APPLICATTON AND A NON-REFUNDABLE DEPOSIT OF$78.00 <br /> I5 REQUIRED. DEPOSITS.WILL BE RETURNED TO THE APPLICANT IF THE FMES/RECORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. <br /> 4. TIM ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL PILE REVTEW FEE <br /> CHARGE. THE BALANCE OF THE CHARGES ARE DUB AND PAYABLE MU TO REVIEWING TELE <br /> 3. kmic FILEs%hCC)RDS NOT RETURNED LN THE SAME CONDTITON A �&CIIVHD WILL BE <br /> ��"BY TTiB 1 it2'3TAFP AT THE FXFfFN9$ OF Al C�;rN :'I'fTiB ADDTITONAL <br /> SERVICE WILL BE WlJWi M THE APPLICANT FOR PAYMENT � <br /> b. ORIGINAL PUBLIC FLLBS/RECORDS SHALL NOT BE REMOVM'kOiK�MM PREMISES. <br /> SIGNATURB OF APPLICANT' - DATE !l 2 q X13 <br /> SIGNATURE OF RELEASING DATE <br /> EH 00 14_(REV 12/92) z <br /> T"J <br />