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SAN JOAQUIN COUNTy <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT � L l- <br /> ADDR-Ess i c Sv10�.n PHONE NO <br /> AGENCY NAME s�a\o•.. S 3.Z c <br /> �2t51`1 .c\� > c cS \�� <br /> ADDRESS v Y1c lc`. PHONE NO <br /> BI.B ADDRESS LH�1D AGE C1� <br /> DATE <br /> 375 <br /> 611 5 <br /> T- o.cy <br /> PAT E <br /> SF <br /> PUBLICf <br /> HEALTH <br /> TI�19 NOTICE is SUBCT TO THE REQUIREMENTS IDENTIMED IN THH PUBLIC HEAL�►SION <br /> JE <br /> S�V'CBSIENVIRONMENTAL tIEALTH DIVISION(EBD)POL.ICy x'92-007, ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EHD PEES AND SERVICE CHARGE RESOLUTIO <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. NS, STATE WATER CODE, <br /> L A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILES/RECORDS REVIEW ARE BY <br /> ARRANGED BY CALLING T O- ti'. APPOINTMENTS ARE <br /> MONDAY 77-CRU (2091 468-0340. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br /> 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-REa NDAE�DEPOSIT OF$78.00 <br /> IS REQUIRED. DEPOSITS WILL BH RbTi1RNl=D TO THE APPLICANT If THE PILFiSPOSIT OF ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. <br /> 4• THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEw FPB <br /> CHARGE. TBALANCE OF THE <br /> ROCUMBNT(S).(S). CHARGES ARE DUB AND PAYABLE PRIOR TO REVIEWING THE <br /> ' <br /> DOCUMENT(S). <br /> S PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS ' <br /> CORRECTED BY THE FETID STAFF AT THE EXPENSE OF THE APPLICANT TNISIADDw7LL BE <br /> SERVICE WILL BE BILLED TO 711E APPLICANT FOR PAYMENT. <br /> 6 ORIGINAL PUBLIC P'LES/RIsCORDS SHALL NOT BE REMOVED FROM THE EHD PRENUSES. <br /> SIGNATURE OF APPLICANT <br /> -� 't• DATE <br /> SIGNATURE OF RELEASING OFFICIAL <br /> EFI 00 14 (REV 12/92) DATE <br />