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I kJ—U23— I �J.`ab '� = ✓J I rM rN.0^ Hlat i '1l, Ge1.7 :r.�o t:l / rfuof _ SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES F.N'VIRONIVIT.PITAL IIEALIH DIVISION PUBLIC RECORDS RELEASE APPLICATION APPIICANT /�l?� CJ I� ei PHONE NO �� g�� :2 � ADDRESS laz7 AGENCY NAME PHONE NO — ADDRESS IDLE ADDRFS5 ICY D T 50 W r,Ti elz,r3s•at, 6 12 �( G> a9 • ML o oofl,p `.( ilo SS 4' s a-L S a 1xC17 ✓U / �7YF£rnen F S 35. 41T ) D � 35. 0 �a3 N - TMS NOTICE IS SUMECT TO 'I"HE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH SER VICESIENWRONMENTAL HEALTH DIVISION LEAD) POLICY 8'92007 , ORDINANCE CODE OF SAN 1OAQUIN COUNTY, EHD FEES AND SERVICE CHARGE RESOLUTIONS. SPATE WATER CODE, GOVERNMENT CODE AND THEEVIDENCE CODE, 1 . A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST, 2 . PIIBIJC Fll -FS/RECORDS REVIEW ARE BY APPOINTMENT ONI_Y'. APPOINTMENTS ARE ARRANGED BY CALLING (209)168 -0340. OFFICE HOURS FOR APPOINTMEN'T'S ARE SCHEDULED MONDAY T 4RU FRIDAY EXCLUDING HOLIDAYS, H:OO A. M. TO 12:00 NOON AND 1 :00 P. M . T04:30 3 - A PUBLIC RECORDS RELEASE APPLICATION AND A NON-REFUND-A1 .E DEPOSI'C OF $78 . 00 IS REQUIRED, DEPOSITS WILL BE REIURNED TO THE APPLICANT IF TTiE FILES/RECORDS ARE NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. 4 , THE AubvE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEW FEE CHARGE. THE BALANCE OP THE CHARGES ARE DUE AND PAYABLERp IOR TO REVIEWING THE DOCUMENT(5). 5 - PUBLIC FILFSIRECORDS NOT RETURNED IN 1014F SAME CONDITION AS RECEIVED WILL BE CORRECTEl7 BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT_ 6 . ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES_ do SIGNATURE OF APPLICANT DATE 07: 4 SIGNATURHOFRELEASING OI FICIAL DATE Ell 00 14 (REV 12/92)