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SAN OA <br /> J QUINCOUNTY J P <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ' APPLICANT Gtr . 'S <br /> r PHONE NO z c7 v <br /> ADDRESS <br /> i AGENCY NAME FRONS NO <br /> ADDRESS 1 <br /> BLE E ADDRESS LEAD AGENCY 12 <br /> 0 IH Ll Pil <br /> f p . ref °I it <br /> I <br /> I <br /> pF <br /> TMS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTLIN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION(EHD)POLICY Ai92-001, ORDINANCE CODS OF SAN <br /> JOAQUIN COUNTY, EHD FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1. A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILES/RECORDS REVIEW ARE BY AkPQINTMfiNT ONLY. APPOINTMENTS ARE <br /> ARRANGED BY CALLING (209)468-0340. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED i <br /> MONDAY THRU FRIDAY EXCLUDING HOLIDAYS, 8:00 A.M. TO i2:00 NOON AND 1:00 P.M. TO 4:30 } <br /> P.M. p <br /> I'I � <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION AND A NOH-REFUNDABLE DEPOSIT OF$78.00 <br /> IS REQUIRED. DEPOSM WILL BE RETURNED TO THE APPLICANT IP THE FILESMECORDS ARE <br /> NOT AVAILABLE WITHIN T 4E CUSTODY OF THE EHD. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THT3 TOTAL FILE REVIEW FEE <br /> CHARGE. THE BALANCE OF THE CAARGES ARE DUE AND PAYABLErpRI TO REVIEWING THE <br /> DOCUMENT(S). <br /> S. PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE �APPIICANT. THIS ADDITIONAL � <br /> SERVICE WILL BE BILLED TO THIS APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVIED:FROM THE EHD PREMISES. <br /> SIGNATURE OF APPLICANT DATE <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 12192) <br /> } <br />