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0^191_ avy <br /> SAN JOAQ[?I7`I COUNTx <br /> PUBLIC UF.A.LTH SERVICES . <br /> EN'VIRONTIEN'T A.L HEALTH DIVLSI(5N <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPIICAN'I` PHONE i10 <br /> ADDRESS <br /> AGENCY NAMEJVvomr[ PHONE NO <br /> ADDRESS 110T. . W. Marc Ln.•, fZc. <br /> FTS$ ADDRESS LEAD AQzENQY DATE <br /> PN9-ft1 D N h I <br /> �ltr/C AA;-e. � <br /> R a lel <br /> 91 -- <br /> ,7. yk s. . 9 <br /> OO 5 i <br /> THIS NOTICE IS,. SUPJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICESIENVIRONMENTAL'M'LkLTH DIVISION(EHD)POLICY!'92-007,ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EI4D FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNNIF-NT CODE AND Tr.E EVIDENCE CODE. <br /> 1. A MA.I&WIA OF TENT (10) PREMISE ADDRESSES PER REQUEST. <br /> 1. PUBLIC FILESIRECORDS REVIEW ARE BY APPOI.NT1.1ENT 0,NILY. APPOINTMENTS ARE <br /> ARRANGED BY CALLING (:09)4634)340. . OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br /> MONDAY THRU FRIDAY EXCLUDING HOLIDAYS, 8:00 A.\J_ TO 13:00 NOON AND 1:00 P.M. TO 4:50 <br /> P.M. <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION AND A NON•REFUNDABLL• DEPOSIT OF 578.00 <br /> IS UQUMED. DEPOSITS 0.71 r BE RLLURNED TO THE APPLICANT IF THE nLES/RECORDS ARE <br /> NOT AVAILI91-E WITHIN Ti4E CUSTODY OF THE END. <br /> 4. 7142 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 /> 5. PUBLIC FILES/RE-CORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. 'IVIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE MD PREMISE'S. <br /> SIGNATURE OF APPLICANT .,tA,de4&AAmk DATE /7'J'e f 199 <br /> SIGNATURE CFR El OFF1C( lU �� Uv✓ DATE I <br /> EH 00 J4 (ILEV 12192) <br />