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-1t1101 � <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> k'N IRONNIENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPI.,ICANT _PHONE N0(`?'6j 3 7/-0413 Y1 <br /> ADDRESS <br /> AGENCY NPHONE NO <br /> ADDRESS <br /> FILE ADDRESS LBAD AGENCY <br /> 313 i,, l eIle 3,13 <br /> 3 z- s-...0/c e«cQ 1 <br /> y4bU S, kWq R`t F�cn ti� (Rr�%'Disc <br /> 4-)33 S Hwf <br /> coc <br /> c4S47 iii <br /> — <br /> PUBLIC�ALH�A1.jH <br /> THIS N(UI*IC F- IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PTJBLIC HEALTH <br /> SERVICES/SNVIRONMENTA.L HEALTH DIVISION(EHD)POLICY 1192-00'7,ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EHD FEES AN6 SFRvgr-T CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND TETE EVIDENCE CODE. <br /> I. A:MA)UMUM OF TEN (10) PRBtIISE ADDMSES PER REQUEST. <br /> 2. PUBLIC FILES/RFCORDS REVIEW ARE BY APPOINTMENT ONLY. APPOINTMENTS ARE <br /> ARRANGE) $Y CALLING (209)468-0340. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br /> MONDAY THR.0 FRIDAY EXCLUDING HOLIDAYS, 8:00 A.M. TO 12:00 NOON AND 1:00 P.M. TO 4:30 <br /> P.M. <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION AND A NON- FUNDABLE DEPOSIT OF S78-00„ <br /> IS RFQTITRF.I). I)F.Pf1.4TT4 WTI 1, RF RFTt_1RNFD TCS THIS APPLICANT IF THE FILtS/RECORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF TM EHD. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEW FEE <br /> CHARGE. THE BALANCE OF THE CHARGES ARE DUE AND PAYAPLE PRIOR TO REVIEWING WE <br /> DOCUMENT(S). <br /> 5. PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> COR"cTtb BY THE IIID STArr AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REIvIOV$D FROM THE EHD PREMISES. <br /> SIGNATURE OF APPLICANT DATEd 9 3 <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 12192) <br /> _ 'd h�'�Tt:�'?iii C„ 4'J't1.� 61}..+•'S:�O L'66t-S�-SCJ <br />