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SAN JOAQUIN COUNTY y <br /> PUBLIC REALTH SERVICES wesT to;t_- <br /> f.. <br /> ENVIRONMFrNI'AL HEALTH DIVISION <br /> n PUBLIC RECORDS RELEASE APPLICATION T <br /> .4 <br /> $ ' APPI.ICANT�VG t AA 20—^ PHONE NO � � LI ri�I" X00�p <br /> ADDRESS <br /> ti AGENCY NAI`�ffi el <br /> _.r�etd(&wX''M"k*4ADDRESS <br /> +ewf�f PHONE No <br /> �y <br /> FELE ADDRESS . IY—AD A(;EM DATE <br /> z; 3909 N. (4j �anQ <br /> //No E�feipr�sa S r <br /> -S/U'Ytl West l,a,,,NQ <br /> 3 S0 7 ro ro vL a o Ave <br /> ,fo25 Corayl�o Ave <br /> our bow St I, C <br /> I�IzC� �yvLhaast Lk&T <br /> 1438 fie�r � St (�-tis <br /> .n <br /> 7II1S NOTICE 19 SUBJECT TO THE REQliIREMENTS IDENTIFIED IN TNS• PUBLIC HEALTH <br /> SERVICES/ENVIRON\LENTAL,.4EALTHDIVISION(EHD) POLICY092-007,ORDINA 'CECODEOFSAN <br /> '. JOAQUIN COUNTY, EHD FEES AND SERVICE CHARGE RESOLUTIONS, STATE NATER CODE, <br /> GOVER`tMENC CODE AND THE EVIDENCE CODE_ <br /> r: I. A ;MAXI\(U\f OF TEN (I0)PREhUSE ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILES/RECORDS REVIEW ARE BY APPOINTMENT`ONLY. APPOINTMENTS ARE <br /> ARRANGED 13Y CALLING ('.03)469-0340. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br /> >�», MONDAY THRU FRIDAY EXCLUDING HOLIDAYS, 8:00 A.M.TO 12:00 NOON AND 1:00 P.M. <br /> P.M. <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION AND A NON•RFFUNDABLE DEPOSIT OF$78.00 <br /> IS REQUIRED. DEPOSITS RILL BE RETURNED TO THE APPLICANT IF THE FILES/RECORDS ARE <br /> NOT AVAILABLE MTHIN THE CUSTODY OF THE FHD_ - <br /> 4. THE ABOVE ID)=NfIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEW FEE <br /> CHARGE. THE BML LNCE OF THE CHARGES ARE DUE AND PAYABLE PRJO TO REVIEWING THE <br /> ,'._. . DOCUMENT(S). - - - - <br /> 5. PUBLIC FILSS/RECORDS NOT RETURNED 1N THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE ERD STAFF AT THE EXPENSE OF THfi APPLICANT THIS ADDITIONAL <br /> SERVICE HILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6, ORIGINAL.PUBLIC FILESIRECORDS SHALL NOT BE REMOVED FROM THE END PREMISES <br /> ISE _ _ q •S ," <br /> y SIGNATURE OF APPLICANT . .0 drT <br /> ; DATE �t / n <br /> SIGNATURE OF RELEASING OFFICIAL 1n--r�k—X/—`-"`� ' DATE 3 f 0) _ <br /> K._" EH 00 14 (REV 12/92) <br />