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* i <br /> SAN ,IOAQUIN.COUNTY <br /> PtIIII,iC III'ALTII SrRVICi+,S <br /> FNVIRONMI:NTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT �j/✓t (i►�n,a�; �D .,%�//S� �1� --PI;ONE NO2 <br /> ADDRESS -70. Aox 7-,) _g� rt&bl Com¢ <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> i <br /> FILE ADDIZE55 LEAD AGENCY DATE <br /> Z z3o E' G,'n S�t�e - — ✓ <br /> 13 S N. F sfr. r, 4,, .� fuer <br /> 2✓c64v <br /> j ZZL �P LSO. <br /> 17z2- f.r- /or ra /a �n <br /> I/a ^• �% Coc — � Cor, <br /> TFIIS NO•I10E IS SUTIJECI 1'0 71113 RPQUIREMP-mrs IDENTIFIED IN 71113 PU13LIC HEALTII <br /> SERVICES/FlNVIRONMENTAL 11FAI TF1 DIVISION (END)POLICY M-007, ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EIID FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNNiENT CODE ANT) THE EVIDENCE CODE. <br /> 1. A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILFVRECORDS REVIEW ARE BY APPOINTMENT ONLY. APPOINTMENTS�ARE <br /> ARRANGED 13Y CALLING (209)468-034o. .. OFFICE HOURS FOR APPOINTMENTS ARE-SCHEDULED <br /> MONDAY THRU FRIDAY EXCLUDING HOLIDAYS, 8:0} 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 RM? JRNED TO TILE APPLICANT IF TIIE Fit-ES/RECORDSIARE <br /> NOT AVAILABLE WF•II1IN TILE CUS'roDY OF THE FIID. <br /> d <br /> 4. THE ABOVE IDENTIFIED DEPOSIT 15 APPLIED TOWARDS THE TOTAL FILE REVIEW, FEE <br /> ('11nRGr. 111E BALANCE OF THE CHARGES ARE DUE AND PAYABLE PRIOR TO REVIEWING THE <br /> DOCUM ENT(S). <br /> (, S. PUBLIC F1LFiSIRFCORDS NOT RETURNED IN 11I133 SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY TILE EIID STn1:F AT THE EXPENSE OF T1113, APPUCANT. THIS ADDLTIONAL <br /> SERVICE WILL BE BILLED 1'0 THF, APPLICANT FOR PAYMENT. t <br /> 6. ORIGINAL PUBLIC FILES/RFCORDS S14ALL NOT BE REMOVED FROM THE E14D PREMISES.. <br /> 11 <br /> SIGNATURE OF APPLICANT c� �, -...,.L.,� DATE <br /> ., . SI(:NA'IURr OF RFI.RASING OFi'ICIAI, DATE <br /> - - --- <br /> k Ell 00 14 (RFV 12/92) <br />