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SAN JOAQUIN COUNTY% <br /> PUBLIC HEALTH SERVICES M t <br /> i ENVIRONMENTAL HEALTH D ' ION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> 3A 1 <br /> APPLICANT Aft-!3 E,1 err.-0,',7 e i PHONEii NO r>%d 7a' <br /> ADDRESS %0 k.,- La S Aox t V,(/-i) CA ys& 74' <br /> AGENCY NAM S PHONE NO <br /> ADDRESS l <br /> RLB,ADDRESS LEAD AGENCY.j DATE <br /> 17 <br /> - <br /> she[ 6 13) 161. St k t-o P Ir <br /> 7.((y L41.L -1 LC; <br /> c -L/ u . fli A.4 I i4 <br /> 6,1 ere, 123(] t f- I <br /> our (c;ojI. CKeuro., 3-1611 „ <br /> II .M <br /> 4 THIS NOTICE IS SUBJECT TO THE REQUMEMENTS IDENTIFIED ;IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION(EHD)POLICY#92-007 ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EHD FEES AND SERVICESCHARGE RESOLUTION , STATE NATER CODE, <br /> k: GOVERNMENT CODS AND THE EVIDENCE CODE. <br /> I. PUBLIC FILES/RECORDS REVIEW ARE BY NT 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. I i� <br /> 2. A PUBLIC RECORDS RELEASE APPLICATION ANDA NONARMDABLE DEPOSIT OF$78.00 <br /> IS REQUIRED. DEPOSITS WILL BE RETURNED TO THE APPLICANT IF THE FIL.I~SIRECORDS ARE } <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THEif <br /> EHD. <br /> 3: THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEW FEE F <br /> CHARGE. THE BALANCE OF THE CHARGES ARE DUB AND PAYABLE PRIOR TO REVIEWING THE <br /> DOCUMENT(S). <br /> 4. PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION ION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHD STAPP AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL' i <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. 11 �R <br /> 5. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BB REMOVED FROM THE EHD PREMISES. <br /> SIGNATURE OF APPLICANTI <br /> d-L I� :, DATE /l- '7- r1 'L <br /> SIGNATURE OF RELEASING OFFICIAL E i DATE <br /> EH 00 14 (REV 10192) <br /> i <br />