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i <br /> SAN JOAQUIN COUNTY <br /> PURLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> } <br /> APPLICANT< , 1�� ° s. PHON R! NO <br /> ADDRESS 'p <br /> AGENCY NAME :, , , 4,► PHONE NOq ijF- 131-15 <br /> ADDRESS <br /> LEAD_AGENCY '$ <br /> YMENT <br /> ?M a 7 <br /> —77;I 'Ium ' .`� ',t_r L , ,,. Ii SAN JQA UIN COUNTY <br /> 11LYJRONNIENTAL <br /> 7c. F 3 o-f- L �-I <br /> �`?J w E I �►i.ftr:�i ��t A, _ •, ; s <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIIRONMENTALHEALTH DIVISION(HHD)POLICY A92-007,ORDINANCE CODE OF SAN ; <br /> JOAQUIN COUNTY, EHD FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, + <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. ' <br /> 1. A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST. <br /> 2. PUrt-*C FILES/RECORDS REVIEW ARE BY AMMOff APPOINTMENTS ARE <br /> ARRANGED BY CALUNG (Z(]9)458-0340. OFFICE HOURS FOR"�APPOINTMRNTS 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.I►'L. I'x � <br /> 3. A PUBLIC RECORDS RELEASE APP IJC.ATION AND A NON-RERUNDABLE DEPOSIT OF$78.00 <br /> IS REQUIRED. DEPOSITS WILL BE RETURNED TO THE APPLICANT'IF THE FUMMECORDS ARE <br /> I` NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. <br /> 4. THE ABOVE IDENTIFIED DEVOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEW FEE <br /> CHARGE. THE BALANCE OF THE CHARGES ARE DUE AND PAYABLE`PRI TO REVIEWING THE <br /> DOCUMENT(S). I? } <br /> I ! <br /> S. PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME.CONDITION AS RECEIVED WILT.BE <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BIJIM TO THE APPLICANT FOR PAYMENT. w <br /> b. ORIGINAL PUBLIC FU-ES/RECORDS SHALL NOT BE REMOVEDFROM THE EHD PREMISES. <br /> 6 1 <br /> 1i L <br /> SIGNATURE OF APPLICANT r'`i ' �. ti '' DATE <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> ETI 00 14 (REV 12192) '? <br /> . i . <br /> i� ,P <br />