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Aq Y <br />SAN JOAQUIN COUNTY FCFMFNT <br />PUBLIC HEALTH SERVICES P S41V C% VFO <br />PUBLICIRONMENTAL HEALTH DIVISION RECORDS RELEASE APPLICATION FhVj �N��y��Q �N`f�0�3V <br />APPLICANT {�P.ilAn��1 Y �P PHONE NO_LL9)S51 -CZoZ% rrh�Msi�lti. <br />ADDRESS ,35y(�' GgKr�a I o ;lr YY1C r1 o tin C/4 C!S x, 7 <br />AGENCY NAME CZ E _ _ _� PHONE; NO <br />ADDRESS <br />K • -7 he+-r-� - <br />K. <br />THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br />SERVICES/ENVIRONMENTAL HEALTH DIVISION CMD) 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 />A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST. <br />2. PUBLIC FILES/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 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-REFUNDABLE DEPOSIT OF $78.00,•. <br />/S 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 CHARGES ARE DUE AND PAYABLE PRIOR TO REVIEWING TUE <br />DOCUMENT(S). <br />3. PUBLIC FILES/RECORDS NOT RE IURNED 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 FILES/RECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br />at <br />SIGNATURE OF APPLICANT �p P IAA y�(�t] / y �%y}.{.9 E DATE q�as�9 <br />SIGNATURE OF RELEASING OFFICIA-L y DATE <br />u< <br />%) EH 00 14 (REV 12/92) <br />1 70"d 26S2TS9t n1 t,10HA [,PJSE:TT '1661-92-90 <br />