Laserfiche WebLink
' ''SAN JOAQUIN COUNTY <br /> DPUBLIC HEALTH SERVICES <br /> ENVIROrmrIEN'T'AL HEALTH <br /> DIMIONty <br /> r <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT t PHONE N0�9I1� <br /> C� <br /> ADDRESS 123 Cinmo s- rc <br /> ES + <br /> AGENCY NAME i►�a�nr-, - �^' �Pc PHONE NO S�vrt _ <br /> ADDRESS ' <br /> 3 <br /> T-17-AD AGEN!Q DATE <br /> FIi DPS <br /> U. ADRS <br /> [.� IlnB ChMne( 6�. �GZ� 3s.2g 3s .�• - r.; <br /> - <br /> a - 7-f q 4/eiled <br /> ._,tGno '130 0.l 4.l►t.��i Lev�r� aNtY rn� <br /> 1 O C <br /> Qr4 L% PAI <br /> 7 0 �tl. cJ oyv lv <br /> raw L� 5z <br /> THIS NMICB IS SUBJECT TO THE REQUIREMENTS ENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION(EHD)POLICYID #92-007,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 MA7QMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST. <br /> PPOINTMEMr <br /> e ONLY. APPOINTMENTS ARE <br /> 2. PUBLIC FILES/RECORDS REVIEW ARE BY - <br /> ARRANGED BY CALLING (209)468-0340. OFFICE HOURS FOR APPOU4 TMBNTS 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-IBM JDABU DEPOSIT OF $78.00 <br /> IS REQUIRED. DEPOSPTS WILL BE RETURNED TO THE APPLICANT IF THE FILES/RECORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL REVIEWVIG FEE Y. <br /> CHARGE. THE BALANCE OF THE CFIARGES ARE DUE AND PAYABLE P$TQ$ Y <br /> DOCUMENT(S). <br /> WILL BE <br /> S. PUBLIC FILES/RECORDS NOT <br /> ARETURNED IN THE SAME B EXPENSE OF B CONDITION <br /> APPIICANT.S 'THIS ADDITIONAL <br /> CORRECTED BY THE EHD STAFF <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE BUD PREMISES. <br /> SIGNATURE OF APPLICANT DATE <br /> f SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 12/92) <br />