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SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> KX VIRONME,NTAL HEALTH DIVLSTON <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT PHONE O <br /> ADDRESS { �T g( NAME <br /> NCX PFIONE NO I `+ .�.r• <br /> ADDRESS <br /> MAR ', 1 1994 <br /> DILE ADDROS LEAD AGENCY DAVIi?wIT/S VICAL ES TH <br /> T�2MITlSERVICES <br /> Lathrop �caq it w(f •17. 9�I <br /> »—I_ S) <br /> if n <br /> r, <br /> r rt <br /> u <br /> t� s <br /> r u • <br /> n • <br /> 'PHIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PU13UC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION(EHD)POLICY#92.007,ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EHD FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATTaR 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 QNLY, 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 13B RETURNED TO THE. APPLICANT IF THE FILM/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 FILM/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 PU13UC FILES/RECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> SIGNATURE OF APPLICANT _ - /.. _.__ DATE d g <br /> v i <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> �\9 EH 00 14 (REV 12/92) <br /> c0'd 0096b9ZT 01 W02id 14UOT :80 t,-GGT-ST-2A- <br />