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-� SAN ,IOAQUIN CO}UN'I'Y <br /> PUBLIC HEAI;I'II SE11VICES <br /> ENVIRONNIEN'I'AL IIEAI;I'II ])]VISION <br /> PUBLIC RECORI)S RELEASEAPPLICEI,'I'ION <br /> APPi-ICANT hM �CyeH,ll GY ,oe,�._P]IONE NO 2d9- yy51' 9ZOy <br /> ADDRESS P. 0, Z4 �s 2 c�l--3oLo <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> FILE ADDRESS ' LEAD AGENCY DATE <br /> -ZZ ^�y Ci'r4vt'a s BIFG <br /> l1 ----- <br /> Ur,y i. /o - <br /> 1CaY� G C11�Itnll <br /> 00 Sel <br /> 1z C l -c <br /> T1I15 NU'IIcF.. Is st1RJECr 'ro I-IIf? RPQUIREMENTS IL)PN'I9PlFD IN THE PUBLIC HEAI.TII <br /> SF,RVICES/FN VIRONMFN'TAL IIFALITI DIVISION (];FID) POLICY#924)07, ORDINANCE CODF OF SAN <br /> JOAQUIN COUNTY, EIID FFF5 AND Si:RVICF CIIARGF RESOLUTIONS, STAT-E WATER CODE, <br /> G0VERNMFN'r CODE ANT) TTIE EVIDENCE CODE. <br /> I_ A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST. <br /> 3 <br /> 2, PUBLIC FILESIRFCORDS RFVIFW ARE BY AP O(NTMEN'i' ONLY. APPOINTMENTS ARE <br /> ARRANGED BY CALLING (209)4h8-[134(1. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br /> MONDAY TFIRU FRIDAY EXCLUDING HOLIDAYS, 90) A.M. TO 12:00 NOON AND 1:00 P.M. TO 4:30 <br /> P.A9. <br /> 3. A PI1III,IC RFCORDS RFLFASF APPLICATION AND A NON-REFUNDABLE DFPoSrr OF $78.00 <br /> Is RI:()IJiRFD. Drl'OSI'1-S WI1,1, 13F RETURNED 0.0 'Tilt APPLICANT IF TILE I:ILFS/RFCORDS ARE <br /> Nar AVAILABLE WITHIN TI1E CUSTODY OF TIME EIID. <br /> 4. THE ABOVE IDEN`fIFITD DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEW FEE <br /> UIIARGE. 'TIIE BALANCE OF 'THE CHARGES ARE DUE AND PAYABLE PRIOR TO REVIEWING THE <br /> DOCUM EN-r(s). <br /> 5, PUBLIC FILFS/RECORDS NOT RETURNED IN'11111- SAME CONDITION AS RECEIVED WILL BE <br /> CORRF(..I'FD 13Y THE EIID STAFF AT' T-Hr,- EXPENSE OF 111173 APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED 'I'O TTiE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILES/RECORDS SI#ALL NOT BE REMOVED FROM THF EHD PREMISES. <br /> a SIGNATURE OF APPLICAN-r j� :c �- DATE <br /> DAT'F �� <br /> F I 1 00 14 (REV 12/92) <br />