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L�a-vi <br /> J • SAN JOAQUIN COUNTY dOp <br /> �- ► PUBLIC HEALTH SERVICES qy.- 2z 5y <br /> W%rMOMIENTAL HEALTH DIV'iSION <br /> PUBLIC RECORI)f RELEASE APPLICAUON <br /> - � <br /> APPJJCANT `U Q AZ a n rri PHONE- NO 7 JW <br /> ADDRESS n S1 <br /> AGENCY NAME PHaN13 NO . <br /> ADDRESS <br /> FILE ADDRa L Al] A EIv Y DATE <br /> 4 tat U r <br /> ST�ri <br /> �l_� <br /> D <br /> 3 d <br /> 1 RA <br /> T US NOTICE IS SUBIECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERViCESIENVIRONMENTAL HEALTH DIVISION(EHD)POLICY#92-007,ORI)INA,VCE CODE OF SAN <br /> ]OAQLIIN COUNTY, rIjD FEES AND SF-RVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVEMMENT CODE AND THE EVIDENCE CODE. <br /> 1. A MAXIMUM OF TEN(10)PREMISE ADDRESSES.PER REQUEST. <br /> 2. PUBIiC FILESIRECORDS REVIEW ARE BY APPOINTMENT ONLY. APPOINTMENTS ARE <br /> ARRIuNGED BY CALLING (2209)468-1344. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br /> MONDAY THRU FRIDAY ECCLUDING HOLIDAYS, 8.00 A.M.TO 12:40 NOON AND L00 P.M. TO 4:30 <br /> PAN1. <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION AND A `O -R-EFU D BLir DEPOSIT OF S78.00 <br /> IS REQUIRED. 'DEPOSITS WILL BE RETURNED TO THE APPLICANT IF THE FILES/RECORD S ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEW FEE , I <br /> CHARGE. TIME BALANCE OF THE C4ARGES ARE DUE AND PAYABLE PRIOR TO REVIEWING THE I <br /> DOCUMENT(S). <br /> S. PUBLIC FILESIRECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIOKAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC F=IRECORDS SHALL NOT BE REMOVED FROM THE EHD PROVOSE5. <br /> SIGNATURE OF APPLICANT DATE 1g A! <br /> SIGNATURE OF RELEASING OEFI AL DATE <br /> EH QO I4 (REV 12!'47) <br /> . I <br />