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10-16-1995 3-59PM � AGE NC 209 956 0700 <br />ADDRESS <br />AGENCY <br />ADDRESS <br />P. 1 <br />SAN JOAQUIN COUNTY <br />PUBLIC HEALTH SERVICES u � u�a -3 � �{ <br />ENVIRONMENTAL EM"'M DI'VLSION <br />PUBLIC RE/CORDS RELEASE APPLICATION <br />S 1e. -►1 r (49�(' jon&vAIFHONE NO (Zoq) CISbozbL( <br />MARch Lftt,i� S�:il.I�k S���K�on C _Zo7 <br />PHONE NO <br />E. R,ic 5fire <br />Ib 5 che�keP 1_nne LoO._ <br />35 N. GheroKee Is' nye L.oAi <br />_225 S ChvrnKre I pgi pa; <br />302z 5 C�grKxc LnftATL.oni <br />i <br />51 q f'. L c0'1 �L.Qrh/Q� <br />2Qo IJ a£cgnMr) R.AD <br />BEo I-.v;c-�ar go(}Q <br />iwS NOTICE IS SUBIECI' TO THE REQUIREMENTS IDENTIMED IN T'14E PUBLIC HEALAV <br />SERVICES/ENVIRONMENTAL HEALTH DIVISION CEIID) 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 />I► • r <br />1. A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST. <br />2, PUBLIC nLES/RECORDS REVIEW ARE BY APPOINTMENT ONLY. APPOINTMENTS ARE <br />ARRANGED BY CALLING (209)469-0740. OFFICE FOURS FOR APPOINTMENTS ARE SCHEDULED <br />MONDAY T HRU FRIDAY EXCLUDING HOLIDAYS, 8:00 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 579-00 <br />IS REQUIRED- DEPOSITS WILL BE RETURNED TO THE APPLICANT IF THE FILESIRECORDS ARE- <br />NOT <br />RENOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. <br />4. THE ABOVE IDENTIFIED DEPosrr IS APPLIED TOWARDS THE TY)TAL FILE REVIEW FEE <br />CHARGE. THE BALANCE OF THE CHARGES ARE DUE AND PAYABLE PRIG TO REVIEWING THE <br />DOCUMENT(S). <br />5. PUREIC PILF_SIRECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED Wn.L BE <br />CORRECTED BY THE END STAFF AT THE EXPENSE OF THE APPLICANT. TIES ADDITIONAL <br />SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br />6. ORIGINAL PUBLIC PILIWRECORDS SHALL NOT BL MMOVED PROM TIE EHD PREMISES. <br />SIGNATURE OF APPLICANT <br />DATE <br />S10NATURE OF RELEASING OFFICIAL DATE <br />Ell 00 14 (REV 12192) <br />