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12-28-199S 2=55PM Fr. AGE NC 209 956 0700 P. I <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> p'UBLIC RECORDS RELEASE APPLICATION <br /> A�'J�Arw) HoI r�o +1 LI <br /> APPLICANT at �} 5 7 <br /> ADDRFSS - ' PHONE NO <br /> rr <br /> AGENCY NAME <br /> ADDMS <br /> n LAGENCY D <br /> 232 p 4 <br /> ;�=_n <br /> 1 E� 19 <br /> `► 1WENViRoNm ITH <br /> —t5 E IT/SERVICES <br /> VIA <br /> TLIIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN TIIE PURI-IC HEALTH <br /> IVISION(04D) <br /> SERVICES/ENVIRONMENTAL HEALTH <br /> EFiD FEES AND DSEYtVICE CHARGE O <br /> RESCLUMONS STATE WATER CODE, <br /> 1 OAQUIN <br /> QOV ERNMENT CODE AND TH13 EVIDENCE CODE. <br /> 1- A MAXIMUM OF TEN (10)PREMISH ADDRESSES PER REQUEST- <br /> PUBLIC FILES/RECORDS REVIEW ARE BY APPa1 f-.NI ONLY. AJ'POINTMENTS ARE <br /> ARRANGED BY CALLING (209)468-0340. OPI7'1Ct- Ii0UR3 POF1 APPOiN11vIENTs '''RE SCHELIULSD <br /> MONDAY THRU FRIDAY EXCLUDING HOLIDAY s, 5:00 A.M. TO 12.00 NOON AND 1:00 P.M.TO 4.30 <br /> P.M. <br /> 3. A PUBLIC RECORDS RELEASE APPL1CATiON ANDA NON-RL:�NDAIII_E DEPOSIT OF 578.00 <br /> IS REQUIRED. DEPOSITS WILL BE REIURNEi)TO THE APPLICANT IF THE H ESJRECORDS ARE <br /> NOT AVAILABLE WIMUN TF R CUSTODY OF THE HHD- <br /> 4. THE ABOVE 1DrtNnFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEW FEE <br /> CHARGE. THE BALANCIi OF THE CHARGES ARE DUE AND PAYABLERY IOR TO REVIEWING THE <br /> ROCU M ENT(S). <br /> S. PUBLIC FILESJR[CORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL OF, <br /> CORRECTED BY THE EHD STAFF AT THE EXPA=NSE OF THIS APPLICANT. THIS ADDITIONAL. <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT- <br /> 6. ORIGINAL PUBLIC FILES/RIrCORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> 1 7 <br /> SIGNATURB OF APPLICANT DATE 1-=f-�' I5 <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 12/92) <br />