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SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br />{' PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT a4Zt L Sic. e Ll PHONE Nc 3 <br /> ADDRESS 3A 3 :5 u m.-c -c j31y yr C_0 -W , C4 5-7g2 <br /> I <br /> AGENCY NAME .0:=A A ,�n�r ver.m�� _PHONE NO <br /> ADDRESS a <br /> FILE ADDEMS LEAD AGENCY DATE I <br /> �cz. , >- Dur 9�f�U� <br /> �) -1 I od - lczh <br /> �) 4- Lau r <br /> &T. t� � <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION(EHD)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. 3 <br /> 1. 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 D fril�7$.00 <br /> IS REQUIRED. DEPOSITS WILI. BE RETURNED TO THE APPLICANT IF THE FI �J +IR��1,�RE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE ERD. EIVED <br /> .tFJt 1 2 1 <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOT <br /> CHARGE. THE BALANCE OF THE CHARGES ARE DUE AND PAYABLE PRIOFtl ma 5 <br /> DOCUMENT(S). FNVI RONM ENTAL HEALTH DIVISION <br /> 5. PUBLIC FILEWRECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. TWS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6: ORIGINAL PUBLIC FILESIRECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> I <br /> SIGNATURE OF APPLICANT DATE - -7 -q 3 <br /> } <br /> O SIGNATURE OF RELEASING OFFICIALr DATE <br /> O� EH 00 14 (REV 12/92) ! <br />