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a SAN JOA.QUIN COUNTY <br /> ' PUBLIC HEALTH S�:RVICF <br /> ON <br /> PUBLIC RECORDS RELEASE APPLICATIQN <br /> APPLICANT f v)i"\/ e✓5 d AA PHONE NO <br /> ADDRESS .--r L:5 ,- 3.3, s AU�p+ �•.ao _Z ".il + S4 l� 3 Yc1 Call-, Afn-tc ws f ZL„GL{stili <br /> AGENCY NAME -- ` PHONE NO <br /> ADDRESS <br /> FILE ADDRESS LEAD AGENCY DATE <br /> PAYMENT <br /> LL1 �`[ i.✓. Y�y,��Y Gam. u <br /> RECEIVED <br /> l5MAR 1? 1 9 <br /> SAN 10*Qt)IN EJ NTS <br /> P1 IBI IC HEALTH SERVICES <br /> J,�, ENVIRONMENTAL HEALTH DIVISION <br /> TI•iTS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION (EHD)POLICY#92-007, ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EHD PEES 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 FILES/RECORDS REVIEW ARE BY APPOINTMENT ONLY. APPOINTMENTS ARE <br /> ARRANGED BY CALLING (201)468-0340. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br /> MONDAY T14RU FRIDAY EXCLUDING HOLIDAYS, 8:00 A.M. TO I2:00 NOON AND 1:04 P.M. TO 4:30 <br /> P.M. <br /> 3. A PUBLIC RfiCORDS RELEASE APPLICATION AND A NONREFUNDABLE DEPOSIT OF$78.00 <br /> IS R,EQULRED. DEPOSITS WILL 13E RETURNED TO THE APPLICANT IF THE FILES/RECORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT 1S APPLIED TOWARDS THE TOTAL FILE REVIEW FEE <br /> CHARGE. THE BALANCE OF THE CHARGES ARE .DUE AND PAYABLE PRIOR TO REVIEWING THE <br /> DOCUMENT(S). <br /> S. PUBLIC FILESIR_EC ORDS Nul'FU--1 UKNhU IN 'll-iE SAME.COND111ON 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. <br /> 6. ORIGINAL PUBLIC FILES/P.ECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> SIGNATURE OF APPLICANT Z�L `' �7�,�� o,_z_ DATE __ 3i/6/"/y <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 12/92) <br /> TOTRL P.02 <br />