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t-K.W AGE NO 209 966 0700 _ P. t <br /> SAN JOAQGN COUNTY <br /> PUBLIC HEALTH SERVICES UAIA <br /> ENVIItOhAKHFA <br /> LTH HLTH DIMION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> lJglUf►�� �M o�A Jil�I�R�I1-I&It Lit•) <br /> APPLICANT ?:.� Cup t�� t olvia No m°t) 5 o .71 LI <br /> ADDRESS of 7 <br /> AGENCY NAME PHONE NO <br /> ADIMMS <br /> LEAD AGENCY <br /> o <br /> Q315 N. t I Damon K+04% P145 -fJ40 <br /> 152c ti cl ceAaft -I- &L_ <br /> 166S r*j. Pacgit. Mc- � <br /> Y fl <br /> . tA it -3.S oto E — <br /> d <br /> 1-6f4 i Ago 14-1 nUZw <br /> D <br /> o1414 1 u.Cl ..� <br /> THIS NOTICE 4S SUWECT TO THE REQUIREMENTS IDSMIFIED IN 711H PUB11C HEALTH <br /> SERVICES/EN VIRONMEWAL HEALTH DIVISION(FSHD)POLICY 1924M7,ORDINANCE CODE OF SAN <br /> JOAQUIN COUNW, END EBBS AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMGNT CODE AND TIM EVIDENCE COD$. <br /> I. A MA36MUM OP IMN (10)PREMISE ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILES/RECORDS REVIEW ARE BY APPOINTMENT ONI.Y. APPOINTMENTS ARB <br /> ARRANGED BY CALLING (209)444.0340. OFnC8 HOURS FOR APPOINlUENTS ARE SCHGDULED <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 RECMI)S RELEASE APPUC ATION ANDA NON-REFU(V1)AHLE DEPOSIT OF 375.00 <br /> IS REQUIRED. 06POSM WILL 90 RETURNED TO THE APPLICANT IF THE FILESJR.ECORVS ARE <br /> NOT AVAILABLE WLTTDN THE CUSTODY OF THE ENR <br /> 4. THE ABOVE 1130MFIED DEPOSIT 19 APPLIED TOWARDS THE TOTAL FILE REVIEW FEE <br /> CHARGE. THE BALANCE OF THE CHARGES ARE DUE AND PAYABLE MOR TO REVLEWM THE <br /> DOCUMENT(S)L <br /> S. PUBLIC F ILOWRECORDS NOT RETURNED IN THE SAME CONDMON AS RECEIVED WILL BH <br /> CORRECTED BY THIi EHD STAFF AT TNG EXPENSE OF 711g APPLICANT. THIS ADDMONAL <br /> SMVICE WILL BE BIT I.FD TO THE APPLICANT POI,PAYMENT_ <br /> b. ORIGINAL PUBLIC F1LFS.I'M9CORDS SHALL NOT BE REMOVED'FROM THE EHD PREMISES. <br /> SIGNATURE OF APPUCANT DATE1.� I <br /> SICIMATURB OF REI..EA81NG OFFICIAL DATE <br /> EH 00 14(REV 12M) <br />