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SAN JOAQUIN COUNTY r <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL IiEALTH DIVISION <br /> PUBLIC RECORDS RELEME APPLICATION <br /> APPLICANT C ,'- '--11 1 � '3 -- PHONE NO <br /> ADDRESS <br /> AGENCY NAME i,i F - PHONE NOq J-I F-`13 i-I 5 <br /> ADDRESS as r i 1O <br /> LEAD AGENCY per$ C <br /> rra,o.,f i Its` !moi/ <br /> PAYMENT <br /> 77 Tan,\ ,r'�'��,,;r,+�: _._ ����," �.. � R��iEAUIN COUNTY <br /> 0 Ila EbJv'RQIWM&NTAL4*AkTH BEY! <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC WEALTH <br /> SERVICESM4VTRONMENTALHEALTH DIVISION(EHD)Policy!192-007,ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EIID FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> I. A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST. <br /> 2. PUrL.=C FILES/RECORDS REVIEW ARE BY APPOINTMENT ONLY. AppoufnwENTS ARE <br /> ARRANGED BY CALLING (209)468-0340. OFFICE HOURS FOR APPORTIMIRM 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 /> �. A PUBLIC RECORDS RELEASE APPLICATION ANDA NON-REFUND DEPOSIT OF$78.00 <br /> IS REQUIRED. DEPOSITS WILL 13F RETURNED TO THE APPLICANT IF THE FUMIRECORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT PS 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 /> S. PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE FIID STAFF XT THE EXPENSE OF THE APPLICANT. THIS ADDMONAL. <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 /> j , <br /> } SIGNATURE OF APPLICANT ,.�; i ^ , �• ti DATE - Zo :ztj <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> 4 .EPI 00 14 (REV 12142) <br />