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SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> NVIRONMV,NTAL HEALTII I) , <br /> Z LIC RECORDS RELEASE APOLICATION <br /> r \ <br /> APPLICANT �1' Tti C m S _ PHONE NO ��r� l -7C,c(-S-? Cp <br /> ADDRESS_1' t n •11!c�.w�l\�I.,,A -Vc <,, C A r't 14 9 ti 1- 1- <br /> AGENCY NAME'"�' `Z CL ._ t �, n e 1 u� 1'JICINR NO <br /> ADDRESSgS <br /> FILE ADDRESS LEAD AGENCY DATE <br /> C' <br /> (tel <br /> AYMEN1r- <br /> CEIVED <br /> -MY 2 4 100 <br /> PRAN i QHEALTH SN OWNT-V <br /> - ,..r.....� cuuionni�AfiAli4L IiiraLt"••,••,`•,• <br /> THIS NOTICE IS SUBJECT To T118 REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMEN'TAL HEALTH DIVISION(EHD)POLICY#92-009,ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, RHD FEES AND SRRVICR cHAROB RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1. A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILES/RECORDS REVIEW ARE BY APPOINTMENT ONLY. APPOINTMENTS ARE <br /> ARRANGED BY CALLING (209)468-0340. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br /> MONDAY THRU FRIDAY EXCLUDINO 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-RBFUNDAELE DEPOSIT OF S?8.00 <br /> IS REQUIRED. DEPOSITS WILL BE RETURNED TO THE APPLICANT IF THE PILES/RECORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE RHD. <br /> 4. THE ABOVE IDENTIPIBD DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEW FEE <br /> CHARGR. TIM BALANCE OF THB CHARGES ARB DUE AND PAYARL13 PRIOR To REVIEWING THE <br /> DOCUMENT(S). <br /> S. PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS.Rl3CBIVED WILL BE <br /> CORRECTED BY THE LM STAPP AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT POR PAYMENT. <br /> 6, ORIGINAL PUBLIC PILRS/RECO"S SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> SIONATURE OF APPLICANT DATE n 3 <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EII 00 14 (REV 12/92) <br />