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10-16-1995 3:59PM F AGE NC 209 956 0700 <br />ADDRESS <br />AGENCY <br />ADDRESS <br />SAN JOAQUIN COUNTY <br />PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DI'VLSION <br />PUBLIC RECORDS RELEASE APPLICATION <br />P. i <br />E. Ryvc Sure <br />Pass=, <br />THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN T14E PUBLIC HEAI:IH <br />SERVICES/ENVIRONMFNTAI. HEALTH DIVISION (FILD) POLICY #92-007, ORDINANCE CODE OF SAN <br />JOAQUIN COUNTY, END 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 riLFS/RECORDS REVIEW ARE BY APPOINTMENT ONLY. APPOINTMENTS ARE <br />ARRANGED BY CALLING (209)46!-0740. OFFICE HOURS FOR APPOIN7MEN'JS ARE SCHEDULED <br />MONDAY THRU FRIDAY EXCLUDING HOLIDAYS, 11:00 A.M. TO 1200 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 $711.00 <br />IS REQUIRED. DEPOSITS WILL BE RETURNED TO THE APPLICANT IF THE PILL-SIRt-CORDS ARE <br />NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. <br />4. THE ABOVE IDENTIFIED DEPOSI'r IS APPLIED TOWARDS THE TOTAL RI -F_ REVIEW FEE <br />CHARGE. THE BALANCE OF THE CHARGES ARE DUE AND PAYABLE FRIO TO REVIEWING THE <br />DOCUMENT(S). <br />S. PUBrIC FILF_WRECORDS NOT RETURNED IN THE SAME. CONDITION AS RECEIVED WILL BE <br />CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. 1111S ADDITIONAL <br />SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br />6. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT Bt, REMOVED FROM THE EHO PREMISES. <br />SIGNATURE OF APPLICANT <br />SIGNATURE OF RELEASING OFFICIAL <br />Eli 00 14 (REV 12/92) <br />DATE <br />DATE <br />4 <br />• ._. �. .• <br />•IT.,: <br />_.• <br />_ <br />Pass=, <br />THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN T14E PUBLIC HEAI:IH <br />SERVICES/ENVIRONMFNTAI. HEALTH DIVISION (FILD) POLICY #92-007, ORDINANCE CODE OF SAN <br />JOAQUIN COUNTY, END 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 riLFS/RECORDS REVIEW ARE BY APPOINTMENT ONLY. APPOINTMENTS ARE <br />ARRANGED BY CALLING (209)46!-0740. OFFICE HOURS FOR APPOIN7MEN'JS ARE SCHEDULED <br />MONDAY THRU FRIDAY EXCLUDING HOLIDAYS, 11:00 A.M. TO 1200 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 $711.00 <br />IS REQUIRED. DEPOSITS WILL BE RETURNED TO THE APPLICANT IF THE PILL-SIRt-CORDS ARE <br />NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. <br />4. THE ABOVE IDENTIFIED DEPOSI'r IS APPLIED TOWARDS THE TOTAL RI -F_ REVIEW FEE <br />CHARGE. THE BALANCE OF THE CHARGES ARE DUE AND PAYABLE FRIO TO REVIEWING THE <br />DOCUMENT(S). <br />S. PUBrIC FILF_WRECORDS NOT RETURNED IN THE SAME. CONDITION AS RECEIVED WILL BE <br />CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. 1111S ADDITIONAL <br />SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br />6. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT Bt, REMOVED FROM THE EHO PREMISES. <br />SIGNATURE OF APPLICANT <br />SIGNATURE OF RELEASING OFFICIAL <br />Eli 00 14 (REV 12/92) <br />DATE <br />DATE <br />4 <br />