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05/22/97- HIti AfAI ...,.... ..• _ ✓,��///�� �i� // <br /> I. <br /> i <br /> 97 <br /> Smi JOAQUII` <br /> f FUBLIC HEALTH SERV-CES <br /> 1 ENVIRONMENTAL REALT" D:EVISION <br /> ' PUBLIC RECORDS RELEASE APPLICATION <br /> PHONE NO '71(-' <br /> APP jCAC7T x.11 k- fy� w. 5 4 cir. <br /> ADDAESS <br /> v«- PHONE NO <br /> AGElyCY N1'<ME� W��_���,• —.__ __�_..---- <br /> j ADD�iIESS <br /> I1 i <br /> BUSINESS NAI9L PROGRAM QR <br /> FUL11 ADDRESS FACC TYPE OF FILE <br /> u 5 r <br /> �aar.S <br /> �o S�� T I_�= � L.G t I S F��t a.✓2 1-�0 LUST U�T <br /> CCN <br /> { I <br /> f <br /> . ### Ytt#t##i**it#*##ti##i##t#####t iiia iii iiiititt ti*•k+tt t#}f}+t#t -. <br /> UULIC HEALTH <br /> THIS NOTICE IS SUBJECT TQ THE REnUVIS ON EHO1 POLICY 1194-007IREMENTS IDENTIFIED IN THE p ORDNA CE CODE OF <br /> SFRVECES/ENVIRON MENTAL HEALTH D <br /> SAN JCA COUNTY, EHD FEE AND SERVICE CHARGE RESOLUTIONS. STATE WATER CODE, <br /> JGOVEIIRNMENT CODE AND THE EVIDENCE CODE. <br /> I <br /> 1 , .A AXIMUM OF IM PREMISE ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILES/RECORD <br /> S REVIEW IS-BY APPOt><iTNtENT O�1LY_-APPOINTMENTS ARE PROCESS- <br /> } ED;BY{ C14LLING f209F468-3420:-OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED MONDAY <br /> THRU FRIDAY EXCLUDING HOLIDAYS, 8:00 AM TO 12:00 NOON AND 1:00 TO 4:30 PM. ` <br /> 3, A �U61_IC <br /> FILES/RECOROS RELEASE APPLICATION IPRRAI IS REQUIRED. <br /> a- 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_ (SEE EHD POLICY 94-007) <br /> S- ORIGINAL PUBLIC FILESMECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> ........... <br /> •- ................. .. <br /> .. <br /> DATE <br /> I SIGNATURE OF APPLICANT <br /> i DATE <br /> SIGN TURF OF RELEASING orFICIAL <br /> EH 00 1 a (REV 9/961 <br />