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1. I <br /> I E7- Jt1—I &b 5: /i1h9 r FCUM1"- HtaC I'A. /, <br /> -T /r/1V/•r/� <br /> SAN N OAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES L/!' <br /> i EN'VIROitiL14EWAL IIEAL77H DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> E APPLICANT �fwtJ r PHONE NO <S�y <br /> ADDRESS <br /> AGENCY NAME —PHONE NCS �--- <br /> ADDRESS <br /> n <br /> RAD AGENCY ' <br /> �7 v� 3 S ac, <br /> - 12 v4 Lr" K ��j. r►tiL <br /> , <br /> 274 <br /> Rff3 S. <br /> D 'i s, <br /> I • <br /> 11115 NOTICE IS SUWE-CT TO ;j'17iE REQUIREMENTS IDENTI(-IrID IN THE PUBLIC HEALTH <br /> SERVICEVENVIRONMENTALHEALTH DIVISION(FOLD) POLICY#974)07,nRDINANCE CODE OF,SAN <br /> JOAQUIN COUNTY, EHDI FEES AND SERVICE CHARGE RESOLVIlONs, STATE WATER CODE, <br /> GOVERNMENT CODS AND'FHE-EVIDENCE CODE. <br /> 1. A MAXIMUM OFTEN (#0).'FREMISn ADDRESSES PER REQUEST. <br /> FiI_ES/R1:CORDS REVIEW ARE IIY A P(]I1LnlFNT ONLY. APPOINTMENTS BARE <br /> r ARRANGED BY CAL.I_ING {204}469-034+0. OFFICE li0URs FOR APPOINTMENTS ARE SCI-II;UULED <br /> MONDAY THRII FRIDAY EXCLUDING]VOLIDAYS, 8:00 A.M. 'r0 12:00NOON AND I:00 P.M:-rct4:30 <br /> P.M. <br /> 1: <br /> 3. A PUBLIC RECORDS RELEASE APPUCA'nON AND A NON-ItE-Fl.!N1 61it.1?upOsrr ors7s.00 <br /> IS REQUIRED. DEPOSrrs WILL BE RETURNED T01119 AYPIIC`.ANT IF'1111: FlLXE-_WRECORDS"ARL <br /> NOT AVAILABLE WITHIN THB CUSTODY•OP THE END. <br /> 4. 'MR AHOV2 IDENTIFIED DEPOSIT IS APPTOW- <br /> ARDS TOWRDS THE TOTAL FILE R6V1EW FE)s <br /> CHARGE. THE BALANCE OF THE CHARGES ARE DUE AND PAYABU Its lUlt TO RL°VIT1v1Nt3 iji>: <br /> A <br /> DOCUMENIIS), <br /> S_ I•UBUC FILESIRECO'RDS NOT RETURNED IN 114E SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY WE EHD S'I AFP AT THE F-XPENSE OF THE APPIJCANT. ` THIS A13DITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT- <br /> b. ORIGINAL PUBIIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE END PREF AIS _ <br /> SIGNATURE OF APPLICANT DATE <br /> SIGNATURE OF RELEASING OF FiCIAI. DATE <br /> E11 00 14 (REV 12142) <br /> i� <br /> k <br />