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SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT L-A-,�r 1c enc (A }�q/0'ix.,�KONE NO Ci 1(0 -q.9�(— <br /> ADDRESS ' v r��� Q,,-A Q-Q-z I C—(A c?SB/S <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> FILE ADDRESS LEAD AGENCY DD <br /> E Cam+ <br /> p i q, <br /> 01--auQu -, :0-15 EIvy <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PU � E TH <br />! SERVICES/ENVIRONMENTAL HEALTH DIVISION(EHD)POLICY 1192-007,ORDINANCEEI <br /> JOAQUIN COUNTY, EHD FEES AND SERVICE CHARGE RESOLUTIONS, STATE VMIMVM <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. 0 CT 1 8 1993 <br /> i. A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST. SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> UBLICHEALTHSERRVICES <br /> 2. PUBLIC FILES/RECORDS REVIEW ARE BY APPOINTMENT ONLY. APpcnlvnr%I)�TVTS"1�tEDIVISiUri <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 MO TO REVIEWING THE <br /> DOCUMENT(S). <br /> 5. PUBLIC FILES/RECORDS 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 /> O SIGNATURE OF APPLICANT/-Y <br /> DATE lb <br /> J.) 1 <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> Ell OO 14 (REV 12/92) <br /> a <br />