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SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> �uf A f 0elm Io" <br /> APPLICANT SjlyiN -)gnii � t-'h kawSk PHONE NO �(�H-�6UU <br /> ADDRESS q 0j w- 6ti e ea- gym& <br /> AGENCY NAME Ho&Qaft, 611 s 4 Si Ka Ell PHONE NO 4 7-'f-aZO U <br /> ADDRESS 2K JU L✓ (u!i Lk L(ME <br /> (A- C � 95 Iq <br /> FILE ADDRESS LEAD AGENCY DATE <br /> Dsc A4, L 44 <br /> I zLM ' <br /> _( $6 N . U--rol ceLw F i L-e A Cc, 951 VO y f) <br /> Q N . Cb.uolLu E ,I-o&k,' CA 1!5 PAYMENT <br /> c1VIle s cc�.ot� �a Ida; CA .s;-Lr RE -FIyFn <br /> J Il L 3 9 i999 <br /> N J rr <br /> PIIRLIC uc^T_ " <br /> ENVIRONNIENid�P,L:J ;Lj I"VI&ON <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION(EHD)POLICY 992-007, ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EHD FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> I. A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILES/RECORDS REVIEW ARE BY APPOINTMENT ONLY. 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 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 PRIOR TO REVIEWING THE <br /> DOCUMENT(S). <br /> 5. 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 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 /> /\ SIGNATURE OF APPLICANT DATE 150 9 3 <br /> \� SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 12/92) z <br />