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SAN JOAQUIN COUNTY <br /> WLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION•" <br /> P LIC RECORDS RELEASE APPLICATION// <br /> APPLICANT TEf��4� L 1 T PHONE NOIR 16)36 <br /> ADDRESS i e rcfe � !a S <br /> AGENCY NAME T DF/Z PHONE NO ['6 d <br /> ADDRESS s J <br /> EM D LEAD AGENCX �A: <br /> Sa q S ru 1_ sS lrt� L) . - <br /> o <br /> eIs <br /> i r <br /> Q 4 S3 i <br /> r <br /> 41/ <br /> ' ius NOTICE ISGT TO THE REQUIREMENT'S IDENTIFIED IN TIB PUBLIC HEALTH <br /> SERVICES/ENVIRO AL HEALTH DIVISION(E[4D)POLICY+x92407,ORDINANCE CODE OF SAN <br /> JOAQUIN COUIV•TY, D FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> M <br /> GOVERNENT CODE THE EVIDENCE CODE. <br /> 1. PUBLIC FILES CORDS REVIEW ARE BY AP ANT ONLY. APPOUMAENTSeARE _ <br /> ARRANGED BY C CG t.ED <br /> (204)468.0340. OFFICE HOURS FOR APPOIIVTMENTS ARE scHm <br /> MONDAY THRU FRIT? EXCLUDING HOLIDAYS, 8:00 A.M. TO 12:00 NOON AND 1:00 P.M. TO X4:30__.:;i:; <br /> P.M. <br /> 2. A pUBLIC RECORDS RELEASE APPLICATION ANDA NoN_N=DA=DEPOSIT OF&78.00 <br /> IS REQUIRED. DEPOS TS WELL, BE RETURNED TO THE APPLICANT IF THE FII.FS/RECORD�'� <br /> NOT AVAILABLE THE CUSTODY OF THE EHD. s <br /> 3. THE ABOVE a ENTMED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIE*Cj'EE <br /> CHARGE. THE BALo CE OF THE CHARGES ARE DUE AND PAYABLE PRIOg TO REVIEWING THE ' <br /> DOCUMENT(S). <br /> 4. PUBLIC FILES CORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WU.L BE <br /> CORRECTED BY THE ffc' <br /> STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE TO THE APPLICANT FOR PAYMENT. <br /> �G S. ORIGINAL pUB FTUOM/RECORDS SHALL NOT BE REMOVED FROM THE EHD FRTphQSES. <br /> SIGNATURE OF APPLICANT DATE 6L3042-1 <br /> ••7 ti -i , <br /> rr <br /> SIGNATURE OF RELE SINC3 OFF[ <br /> CI DATE <br /> EH 00 14 (REV 10192) <br /> i ' j - 2C . 11 26i0E/0i Wpbj <br />