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Plea 2 I -1 c�t�e �< iU <br /> ?tu <br /> �SAN JOAQuuv couNTYAPUBLIC HELTH SERVICES rlsL a y� <br /> ENVIRON)\IEENTAL HEALTH DIVISION <br /> PUBLIC R. <br /> jCO S RELEASF APPLICATION / <br /> APPLICANT U20.c Q n lP-ti (t ona ,PHONE NO L167-IJ06 <br /> i2�� CJeO n tl f f 2n <br /> ADDREss�t 005 l,t�t Son �. , Sl'ocK'i-ob : CA R5d0z; <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> cm S--ocv--for, rwU <br /> FU-9 ADDRESS F— ' J LEAD AGENCY DATE <br /> -C L f-.f l��1 <br /> r a Vl0 <br /> 8a5 E. [3� <br /> 3333 0.I,t).esTl.a V) 0 <br /> a 800 _ + he I V) <br /> 1 ;z r7 E • <br /> roa uua Vnc) <br /> 0 1 a �/cr <br /> gas N. VIULDR) sr. t, rolnfD r, 0 <br /> 7a i M . Umimj ST. lAc--�F <br /> THUS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVTRONMENTAL HEALTH DIVISION (EHD) POLICY #92-007, ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EID FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> I. A MAX MUM OF TEN (10) PREhUSE ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILES/RECORDS REVIEW ARE BY APPOINTMENT ONLY. APPOINTMENTS ARE <br /> ARRANGED BY CALLING (209)468-0340. OFFICE HOURS FOR APPOINTAiENTS ARE SCHEDULED <br /> MONDAY THRU FRIDAY EXCLUDING 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 APPLICATION AND A NON-REFUNDABLE DEPOSIT OF 578.00 <br /> IS REQUIRED. DEPOSITS RILL BE RETURNED TO THE APPLICANT IF THE FILES/RECORDS ARE <br /> NOT AVAILABLE WITHIN T74E CUSTODY OF THE F14D. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS 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 /> 5. PUBLIC FILES/RECORDS NOT RETURNED 1N THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE E-ID STA-FP AT THE EXPENSE OF THE APPLICANT. TMS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE E-ID PREMISES. <br /> SIGNATURE OF APPLICANT Zt/X/k Q DATE // 9 <br /> SIGNATURE OF RELEASING OFFICIAI�'1 '( �ll� Iver�� �(, )n,��:1 DATE Lk 1 <br /> -11 ( " mry 1-11" j <br />