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SAN JOAQUIN COUNTY GC ccz L, 3 y <br /> PUBLIC HEALTH SERVICES _ <br /> ENVIRONMENTAL HEALTH DIVISION r`z <br /> PUBLIC <br /> RECORDS RELEASE APPLICATION <br /> APPLICANT � , 1 S PHONE NO / <br /> 1Z-5-6 Y- Z 2 Uy <br /> ADDRESS <br /> Se«fv sir 95"s%iS <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> FILE ADDRESS LEAD AGENCY DATE <br /> /Ol( IJryu d w« /) F Fa <br /> 1700 Al 40/D-5 c <br /> I r7o /y. 1-0'o <br /> ) S700. 54� Lo /' <br /> HLIP, 54 w <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION(EHD)POLICY#92-007, ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EHD 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 FLLES/RECORDS REVIEW ARE BY APPOINTMENT ONLY. APPOINTMENTS ARE <br /> ARRANGED BY CALLING (209)468-0340. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br /> MONDAY THRU FRIDAY (OCCLUDING 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 $78.00 <br /> IS REQUIRED. DEPOSITS WILL BE RETURNED TO THE APPLICANT IF THE 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 CRARGES ARE DUE AND PAYABLE PRI TO REVIEWING THE <br /> DOCUMENT(S). <br /> 3. PUBLIC FILESIRECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FII-ES/RECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> SIGNATURE OF APPLICANT DATE <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 12/92) a <br />