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ttilly v <br /> -� --y, 00/061 <br /> U SAINT JOAQUIN COUNTY �� " 'c' LUUU <br /> PUBLIC HEALTH SERVICF,S ENVIRO,INMEWAL hEALTH <br /> ENVIRONIVILENTAL HEALTH DIVbSION PERIAIT/SERVICaS <br /> FUI3LIC RECORDS RELEASE APFUCATION <br /> APPUCANT Pn�l�u ee-d _ PHONE NO _ 3l�? <br /> ADDRESS 3 <br /> AGENCY <br /> ADDRESS <br /> ELLE ADDRESS L.BA,P AGB=Y <br /> si 15 <br /> X3 3 TtaS"r� RoA-r 11tc o— <br /> / ,;I-o 60 <br /> v 3 g 80 �) AlZLi&<_ <br /> / 3 s-9918 rtJ G f-Ctis� <br /> THUS NOTICE IS SUBJECT TO T1IE S IDEU-,PERD IN THE PUHLIC ASAL.TH <br /> SERVICES(ENVIRONMENTAL HEALTH DIVISION(MM)POLICY A gZw7,ORDINANCE CODE OP SAN <br /> JOAQUIN COCJNTY, IM NESS ANP SERVICE CHARGE RESOLUnONS, STATE WATER CODE, <br /> (IOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1. A MAXMUM OF'TEN (10)PRBMLSE ADDRESS8S pML REQUE$T. <br /> 2. PUBLIC Fly BS/RECOIRDS REVIEW ARE BY AUQINMM ONLY. APPOINTMENTS ARE <br /> ARRANOHD BY CALLTNG (209)464-0340. OpFICE HOURS VOR APPOINTMENTS ARE SCHEDULED <br /> MONDAY TfI RU 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-REFUI jpa DEPOSIT OF$78.00 <br /> IS REQLMUD. DEPOSITS WILL BE RETURNED TO THR APPLICANT IF TFW FILTiS/RECORDS ARE <br /> NOT AVAILABLE WTTI-Il'.N TILT CUSTODY OF THE EHD. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVMW F'E)g <br /> CHARGE. THE BALANCE OF THE MARGFS ARE DUE AND PAYAUE,p U TO R$VM%rWG THE <br /> DOCUMENT(S), <br /> 5. PUBLIC FILM/RECORDS NOT RETURNED IN THE SAA4E CONDMON AS RECEIVED WILL,IBES <br /> CORRECTED BY THE BHD STAFF AT THE FI PENSB OF THE APPUCANI'. THIS ADDMONAL <br /> SERVICE WILL BE BILLED TO THE AppLICANT I.OR PAYMENT. <br /> 6. ORIGINAL PUBLIC Fit..BS/RECORDS SHALL NOT BE REMOVED PROM THIi ERD pREWSFS. <br /> SIONATURFi OF APPLICANT DATE _ v <br /> t <br /> SfGNATURE OF RELEASING OFFICIAL, DATE <br /> P-H 00 14 (REV f 2192) <br /> s1 <br /> 10/10 30V8 N~ZVi N ZZZZv9s9I6 90:60 OOOZ/7,0/EO <br />