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{R SAN JOAQUIN COUNTY. <br /> PUBLIC I3EALTH SERVICES <br /> ENVIRONMENTAL HEALTII DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION �jFF <br /> 11 k <br /> OIL)' APPLICANT - `k r�c_c A K c-1iONE NOG 1 - <br /> ADDRESS ! C.L.•C Qe 5'o'\�-►-�a r c-k 8!S ' <br /> AGENCY NAME <br /> PHONE NO <br /> ADDRESS <br /> FILE ADDRESS LEAD A ENCY. DATE <br /> -. k <br /> A <br /> 44 <br /> O e� g <br /> o (o <br /> v 5 <br /> TIiI O CE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PU$�I� ETH, <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION (EHD)POLICY/192-007,ORDINANCE t+�b <br /> s JOAQUIN COUNTY, EHD FEES AND SERVICE CHARGE RESOLUTIONS, STATE <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. OCT . 1 8 1993 <br /> I. A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST. SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> 2. PUBLIC FILESIRECORDS REVIEW ARE BY APPOINTMEN1 ONLY. <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 LIDO P.M. TO 4:30 <br /> P.M. <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION AND A NON-REFUNDABL DEPOSIT OF$78.00 <br /> 1S 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 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 /> Q SIGNATURE OF APPLICANT DATE 161-71j2 <br /> [� SIGNATURE OF RELEASING OFFICIAL DATE . <br /> s <br /> F11 00 14(REV 12/92) <br /> i <br /> i <br />