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SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> �-�r A - 0�wwl� <br /> APPLICANT V i� -jo1n w (cnw k PHONE NO 4('7 qU O <br /> ADDRESS r� W. � - lrwti� <br /> AGENCY NAME N o&Qat-, , G;71 lis , e Sr`.�w �l l� PHONE NO � ��C o CO <br /> ADDRESS _ I,✓. f -r�Jln L - <br /> 0ATEE�i���S- C R s (q <br /> FILE ADDRESS LEAD AGENCY D <br /> m-W, �o lcS� r� <br /> C A 116 r� <br /> r 35 N. Cw--roi(tt F l c AA' Cr. 9 5.1 VO �Y/ (1, <br /> �z N. G�arot�ec E r 1 dk.' Col 1!5 a 4 O PAYMENT <br /> RECEIVED <br /> ill . .. <br /> ENVIRONNIEI4 1 AL i;tF,L;LE ;141iSION <br /> "ITS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION(EHD)POLICY#92-007,ORDINANCE CODE 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 APPOINTMENT ONLY. APPOINTMENTS ARE <br /> ARRANGED BY CALLING (209)468-0340. OFFICE HOURS FOR APPOINTMENTS 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-REFUNDABLE DEPOSIT OF$78.00 <br /> IS REQUIRED. DEPOSITS 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 FILE REVIEW FEE <br /> CHARGE. THE BALANCE OF THE CHARGES ARE DUE AND PAYABLE PRIOR TO REVIEWING THE <br /> DOCUMENT(S). <br /> 5. PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE END PREMISES. <br /> \ SIGNATURE OF APPLICANT DATE 3v q 3 <br /> \ SIGNATURE OF RELEASING OFFICIAL_ DATE <br /> Ell 00 14 (REV 12/92) y <br />