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I k?tirJC-I yob b:elorrv'i rrury rur. r.0 �.00 ,+.�..+ u•�• // ,J� <br /> SAN JOAQUEq COUNTY JJJJJ <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONN[ENTAL HEALTH DI'YISION y oc) <br /> J/ PU11LIC RECORDS RELEASE APPLICATION <br /> (�I f/ � �� PIIIIO�NE�NO <br /> APPLICANT <br /> ADDRESS & f)nl c' <br /> AGENCY NAMES S ms's c1 __PHONH NO <br /> ADDRESS <br /> EUX ADDRE' S LEAD AGENCY DAT B, ' <br /> 4Z�1nJiTXt7— h _ . <br /> S 1 _ <br /> vj L1 <br /> IllB 2 V4S: . A'{'r N (J <br /> 137J, _ry cyelx� n <br /> 11115 NOTICE IS SUBJECT` TO TIM REQUIREMENTS IDEN9-IFIED W THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION (EHD)PO[ICY#92-007,ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EHD FEES. AND SERVICE CHARGE RESOLUTIONS, SPATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> I. A MAXIMUM OF TEN (10)PR.EMISB ADDRESSES PER REQUEST. <br /> 2_ PUBLIC FILES/RECORDS RFVIEW ARE BY APPOMI-MENT ONLY. APPOINTMENTS ARE <br /> ARRANGED BY CAi1JNG (209)468-0340. OFFICE HOURS FOR APFOIN"I'MEN"15 ARE SCHEDULED <br /> MONDAY TNRU PRIDAY EXCLUDING HOLIDAYS. 8:00 A.M. TO l2:00 NOON AND L00 P.M. TO 4:30 <br /> P.M. <br /> 3. A PUBLIC RECORDS RELEASE APl`LICATl0N AND A BION-RGFl1N j&jlj j; DEPOSI"T OF $78.00 <br /> IS REQUIRED. DEPOSITS WILL BE RETURNED 1.0 TIIH APPLICANT IF TIIL' FILES/RECORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. <br /> 4_ THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL_ FILE REVIEW FEE <br /> CHARGE. THE BALANCE OF THE CHARGES ARE DUO AND PAYABLE PRIOR TO REVIEWING THE <br /> DOCUMENT($). <br /> 5. PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RFCEIVED WALL BE <br /> CORRECTED BY THE FHID STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM TILE EHD PREMISES. <br /> SIGNATURE OF APPLICANT I� / BATE <br /> SIGNATURE OF RELEASING Of <br /> FIC DATE <br /> EH 00 14 (REV 12/92) <br />