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5-13-1 sf-A6 4: 58PNI <br />c \� <br />FP^' 4 AGE NC 20 3 ``+bb b i UU <br />SAN JOAQUIN COUNTY <br />PUBLIC HEALTH SERVICES <br />M%fVWONKDUAL HF.ALTg DIVISION <br />PUBLIC RECORDS RELEASE APPLICATION <br />APFIICANT K p v't vl M G i l PHONE NO— <br />ADDRESS <br />AGENCY NAME Iva a C +o Est U i v a� ► +it • K� x PRONE NO <br />ADDRESS ('50 ""- Marc L r? - SLc 5 ec, toles <br />'0.1,.` :. ! • ; <br />t Sb <br />IV- B v4dEQy flvR <br />1 705' <br />N. $rvddwq� AV . <br />1760 <br />W- B.oad wa f i il4 . <br />3q3 f <br />gai w•t+scr LC <br />I 141$ <br />5tiaw <br />lgoa <br />51642w R <br />2f3'i <br />C �n•ro�+e t <br />3 S35 <br />�- 30 6� <br />7 C-O;?6 <br />THIS NOTICE IS SUBJECT TO THE REQUIR-NIGNTS IDENTIFIED TN THE PUBLIC HEALTH <br />DE OF <br />SERVIMN SONNY,, El -LD FEES AND USERVICE CHARGE RESOLUTIONS, STATEIVISION (EHD) POLICY �*2-W7, C O <br />wATER CODE <br />JOAQ <br />GOVERNMENT CODS AND THE EVIDENCE CODE. <br />I A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST. <br />2. PUBLIC RLESlRECORDS REVIEW AF1E BY 6? NT ENT_QNL•Y• APPOINTMENTS ARE <br />ARRANGED EY CAVING (209)4'68-'0340- OFFICE HOURS FOR APPOIN-nMENTS ARE SC"EDULED <br />MONDAY TI -MU FRIDAY EXCLUDING HOLIDAYS. $:00 A.M_ TO 12.00 NOON AND 1:00 P.M. TO 4--10 <br />P.M. <br />3. A PUBLIC RECORDS RELEASE APPLICATION AND A NON-REFUNDA,I E DEPOSIT OF S78.00 <br />IS REQurRED. DEPOSITS WILL BE RETURNED TO THE APPLiCANI' IF TELE FILESIRECARDS ARE <br />NOT AVALLASLE WrTHIN THE CUSTODY OF THE EHD. <br />a. THE ABOVE IDENTIFIED DEPOSIT IS APPIlED TOWARDS THE TOTAL PILS REVIEW FEE <br />CHARGE. THE BALANCE OF THE CHARGES ARB DUE AND PAYABLE PRIOR TO REVIEWING THE <br />DOCUMENT(S). <br />5. PUBLIC FILESMECORDS NOT RETURNED IN TILT SAME CONDITION AS RECEIVED WILL BE <br />CORRECTED BY THE IIID STAFF AT THE EXPENSE OF THE ADPL``CANT. Tills ADDITIONAL <br />SQtVICE WML BE BILLED TO THE APPLICANT FOR PAYMENT. <br />5. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE EHD PRIINUS -S- <br />SIGNATURI3 OF APPLICANT <br />SIGNATURE OF RELEASING OFFICIAL <br />EH 00 14 (REV 12192) <br />4f,t 4 <br />DATE <br />