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• SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES• <br /> EIWIRONNIENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT e i v o e 0 l-' . 1'3 E YE <f PHONE NO (:D/"3 ) <br /> ADDRESS 4o yE S4V N61 F A yER/C19 Of PT 2717 <br /> vo NrR h.¢.a o�9 L'•CL✓ininA c� C 'f 9�7 a6-iyt n• <br /> AGENCY NAME PHONE NO_LM— <br /> ADDRESS cK7- 'r- <br /> FILE <br /> FILB ADDRPSS LEAD PAYMENT RWMEn <br /> - eys�g� «FA �,� z sg ✓ eA ✓. NOV 0 1 1"1 <br /> J ��o NJ�' <br /> S< e 114l✓E_TT FR 6�f v.✓T ST, /-',U� /ENO <br /> ENVIRONMENTAL HEALTH Dlyi�iQ^! <br /> _.., -u.�s� �-.yE✓i2 ocFT s-.r .✓ So.aq✓ice/ c�e'n/f`J <br /> SUZY N, VA../ ,g-'4Z 6-./ Sr Q4's E'NG <br /> .N^.O Cf Z'3 �/ �1fn70/Soil/ ST, - <br /> ST� � KT a.✓ c..q <br /> -' /3 -a.✓.r.f-,C ms's c,o i,/,p s.y n/ JvA a✓i.✓ ��us1i' <br /> � i7-7' .7-.0 <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICE&MNVIRONMENTAL HEALTH DIVISION(EHD)POLICY+/92-007,ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EM 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 FILESIRECORDS REVIEW ARE BY APPOINTMENT ONLY. APPOINTMENTS ARE <br /> ARRANGED BY CALLING (209)468-0340. 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. TO 4:30 <br /> P.M. <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION AND A NON-RFPI_aMA_RI G DEPOSIT OF$78•00 <br /> IS REQUIRED. DEPOSITS WILL BE RETURNED TO THE APPLICANT IF THE FILM/RECORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE ERD. <br /> a_ TH$ ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEW FEE <br /> CHARGE. THE BALANCE OF THE CHARGES ARE DUE AND PAYABLE PRIOR TO REVIEWING THE <br /> DOCUMENT(S). , <br /> S. PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDYLION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHD STAFF AT THE 02WSE OF THE APPLICANT. THIS ADDMONAL <br /> SERVICE WIM BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FlLEMCORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES_ <br /> 5IGNATURE OF APPLICANT DATE is o T. ♦9 <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 12/92) <br />