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5-13-16 a:58PM <br /> FPIM AGE NC LWy <br /> , 1 3 <br /> SAN 7OAQuiN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENv RoNrvuz TAL SF.ALTH DIVISION <br /> �n PUBLIC RECORDS RELEASE APPLICATION <br /> M <br /> ApFL1CANT K tyi n 4Krlry+h PHONB NO <br /> ADDRESS ,yI a PRONE NO`97 <br /> AGENCY NAME aN[. G'° En✓!von <br /> ADDRESS I$OW. Marc <br /> i,n. SL< Sic o <br /> I- .8 Li <br /> IIADDT�� <br /> LEAD AGBNCY DATE <br /> —1 <br /> 5'6 N- Broadvect Flue . fns E h f1 <br /> 17p 5' AI Broa�w4 �Ye , <br /> 1700 N- Bro�urd f1 - <br /> 3q32 Bu wciscr G� <br /> 16 44i Shaw ria <br /> 1300 Shaw <br /> 114-1 5114v 17 <br /> 43 i rj E >Mt7+rEo0 <br /> 2Z3'S' C h•rol�e t <br /> 3,5'35 C6rooK{@ — <br /> 36bTHIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED L`1 TILE PUBLIC HEALTH <br /> SERVICES/ENVIRONMFNTALHEALTH DIVISION(END)POIJCY:92-007.ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EiLD FEES AND SERVICE CHARGE RESOLUTIONS, STMT WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1. A MAXIMUM OF TEN(10)PREMISE ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILES/RECORDS REVIEW ARE BY A°00INIMFNT ONLY. APPOINTMENTS ARE <br /> ARRANGED BY CALLING (209)468-0340. OFFICE HOURS <br /> FOR <br /> APO0 NO AND POINTMENTSIAO P.MSCHEDULED <br /> ED ED <br /> MONDAY THRU FRIDAY EXCLUDING HOLIDAYS, 6:W <br /> P.M. <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION AND A NON-REFUNDABLE DEPOSIT OF$79.00 <br /> IS REQUIRED- DEPOSITS WIU. BE RETURNED TO THE APPLICANT IF THE PILES/RECORD3 ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. <br /> 4- THE TOTAL F11,5 REVIEW FEE <br /> CHARGE. THE BALANCEOF <br /> ED DEPOSIT IS TRE CHARGES ARE DUE AND P�AYABLLEEPRIOR TO REVIEWING THE <br /> DOCUMENT(S). <br /> 5. PUBLIC FILES/RECORDS NOT RETURNED IN TIME SAME CONDITION AS RECEIVED WILL HE <br /> CORRECTED BY THE EHD STAFF AT THE ERPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC KLESMBCORDS SHALL NOT BE REMOVED FROM THE EI4D PREMISES. <br /> SIGNATURE OF APP3ICANT 4fu DATE I Ila% I cf <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 12192) <br />