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SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES '1 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT (APZTA�F ONE NO G t to -9,�I 7-iO S';;� <br /> ADDRESS <br /> .AGENCY NAME PHONE NO <br /> ADDRESS <br /> FILE ADDRESS LEAD AGENQL( DATE <br /> e e` 2? �• c�-k�k - <br /> ri o (v <br /> THIS NOTICI; IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PU ALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION (EHD)POLICY#92-007,ORDINANCE <br /> JOAQUIN COUNTY, EHD FEES AND SERVICE CHARGE RESOLUTIONS, STATE VA%lmw% <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. O C IS 199 <br /> I. A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST. SAN JOAQUIN COUNTY e <br /> PUBLIC HEALTH SERVICE_, <br /> ` 2. PUBLIC FILESIRECORDS REVIEW ARE BY APPOINTMENI ONLY. �APVR1v[) � �IVISI(}ri <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-PEFUNDABLI 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 MOOR 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 EHD PREMISES. <br /> �Q SIGNATURE OF APPLICANT f DATE lb <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> 01 00 14 (REV 12192) <br /> a <br /> i <br />