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I IO-i[]ti-I J-J'b b:11trtN� rrcurr N,�,c �•f,, crr.:r .:,:_,cam r.r.cx, //" ,"`J�� <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES L�r <br /> ENVHtOMEENTAL HEALTH DIVISION r''U <br /> P'URLIC RECORDS RELEASE ASE APPLICATION <br /> / s <br /> APPLICANT ( i �dld�s�J �1 PHONE NO �d,4;p a:—Z!t7 <br /> ADDPJRsS <br /> AGENCY NAME <br /> ADDRESS <br /> } <br /> ADDRESSLEAD AGENCY <br /> Q � � r�"r�•,-►�,-f._ '� 35.1 n,c, <br /> m 14 3s, rn <br /> 2 ` a -. m�, <br /> Ism — 1 <br /> "THIS NOTICE IS SUBJECT TO T11B REQUIRE=MENTS IDE74Tf ED IN THE PUBLIC HEALTH i <br /> SERVICES/ENVIRONMI~NTAL HEALTH DIVISION (FID)POLICY x"42-007,ORDINANCE CODE OF SAN <br /> 30AQUIN COUNTY, EIlD FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODS. <br /> L. A MAXIMUM OF TEN (10)PREMISS ADDRESSES PER REQUEST. <br /> 2. P4180C.' FILESIRECORDS REVIEW ARE BY &PPOINT10ENT ONLY. APPOINTMENTS ARE <br /> ARRANGED BY CAUJNO (209)468-0340. OFFICE HOURS FOR APPOIN NIEN'TS ARS SCHEDULED <br /> MONDAY T"RV PRIDAY EXCLUDING HOLIDAYS, 8.00 A.M. TO 12:00 NOON AND L:00 P.M_TO 4:30 <br /> I <br /> 3. A PU13UC FIE-CORDS RELEASE API*UCA'EION AND A tj0tj_Rr-r-UN[),& _I?DIiPOSIT OF$78.00 <br /> IS REQUIRED. DEPOSITS WILL., 013 Rh-1 JRNED 1'0 TIIE APPLICANT IF THE FILES/RECORDS ARE <br /> NOT AVAILA$LS WITHIN TUB CUSTODY OF THE BED. <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(5)., <br /> S. PUBLIC MILES/RECORDS NOT RETURNED IN T14E SAI`IE CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EMD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDMONAL <br /> SERVICE WILL BE BILLED TO 714E APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILES/RECOILD3 SHALL NOT BE RFMOVED FROM THE EHD P"MISES. <br /> SIGNATURE OF APPLICANT DATE 0 <br /> SIGNATURE OF RELEASING Of FICIAL DATE ! <br /> EH 00 14 (REV 12/9))- <br /> 7 <br />