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8- 1 1 - 1 ya5 4 : 58Rf 1 I- HUtl AUt l �� <br /> 143 �y <br /> M SANjo &QUIN COUNTY <br /> PUBLIC FFA LTIT SERLiir S <br /> ENVIRONMENTAL F11F.ALTH DIVISION <br /> IYI7�LIC i � ?RDS RELFASE APPLICATION <br /> Z& T <br /> APPLICANT ' —=-2Y"- - -PAG`ris NO__ 1�A <br /> ADDRESS. PRONE_ x PHONE NO V <br /> AGB?CY NAME �C , <br /> ADDRHS3 ` <br /> DATE <br /> LFA <br /> qtr yr ADI M!i <br /> • bl" ci _. . . . rte S ' — T-tea G� aZ3 . 1'11 <br /> k <br /> /(o W <br /> tf <br /> Bl p6d �(iYU ihl ..Z 3 5'0 <br /> TIRS NOTICE IS SUIUECT TO TIM REQIJIREMFN'IS IDENTIFIED IN TIIE PUOUC HHALTII <br /> SERVICp.SIENvIRONMCNerAlHEALrnI DIVISION <br /> ( I 2 -007 , SUTCO ` <br /> sAN <br /> IOAQUIN COUNTY. AID rEES AND SERVICE CIIAItG' ERESOLUTION . SATW DE, <br /> OOVER29MENT CODE AND THE EVIDENCE CODE. <br /> I . A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST. . _ . <br /> 1.. PUBLIC TILES/RECORDS REVIEW ARE KY Al'Ptli NTb1ENT tINL.Y . APPOINTMENTS ARE <br /> ARRANGED BY CAIIJNG (209)468-0340. OFFICE HOURS FOR APt%OINTLtEN'IS ARE SCIiEDULED <br /> MONDAY IIIRU FRIDAY EXCLUDINO IIOUDAYS, 8:00 A. M. TO 12:00 NOON AND 1 :00 P. M. TO 4 :30 <br /> P. M . <br /> ; , A PURLJC RECORDS RELEASE APPLICATION AND A NOI,+ -RtYUND{ISLE DEPOSIT OF <br /> $78. 00 <br /> IS HEQUHLLD. DEPOSITS WILL BE RETURNED TO 111E APPLICANT IF THE I•ILESIRECORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF 111E EIID. <br /> 4 . THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TO"rAL FILE REVIEW FEE <br /> _ CHARGE. THE BALANCE OF THE CHARGES ARE DUE AND PAYABLE 17KI(IR TY3 REVIEWING THE <br /> i DOCUMENT(S). <br /> { <br /> i <br /> 5- PURU(: PILES/R ECORUS NOT REI'IIRNED IN THE SAME CONDITION AS RECEIVED WILL B <br /> CORRECTED BY THE EiID STAFF AT 711E EXPENSE OF THE APPLICANT- "17-llS ADUITIONAI. <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT, <br /> 6. ORIGINAL PUBLIC FILFSVRECORDS SHALL NOT BE REMOVED FROM THC E11U FReMISfss. <br /> Sir:NATIIRE OF APPLICANT 'j, J& . DATE <br /> SIONATURP OF RPLRASING OFFICIAL DA'rF <br /> FH 00 14 (REV 12/92) <br />