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ji <br /> 'L c L/IrM -- .__ !`ttt A"1—Rl9G �VCi"cewr .xX� v r�w----• -- � �L/ <br /> SAN JOAQUTN COU-NW <br /> PUBLIC HSA,LTH SERVICES <br /> F.NVIRONMENrAL HEALTH I7I'VLSI N <br /> PUB LIC RECORDS RELEASE APPLICATION <br /> APPLICAN'P�fl���^ PHONE NO <br /> ADDRESS PHONE NO `� �'0.26 <br /> AGENCY NAMDTw- <br /> vamc- rj�o E,�✓�yoylrrl•vt al <br /> ADDRESS 1�O Marc <br /> FfL5 AT�T)RT�SS =C DATFs I <br /> fit} _ <br /> 3r-9 _farK 4v <br /> yZZ �'/.erre A�vt, k*116 <br /> - <br /> -r.� .3S• 3a <br /> Tlf]S NUlTCL ISSliT3JECT TO THIS REQUIRENSENTS IDENTIFIFD Rl' 'I'IAE PUBLIC HEALTR <br /> SERVIC> SIENVIRO`;\I1 ,"s'TAL 42ALTII DIVISION(E14D)POLICY 4-92-007,CRllINIANCE CODE OF SAN <br /> JOAQUIN COUNTY, 0413 FEES AND SER%lCE CHARGE RL-SOL.UTICKS, STATE WATER CODE. <br /> GOVERNMENT CODE AND TrI:EVIDENCE CODE. <br /> r <br /> 1. A �fA.`oMUbi Or TEN (10)PREN11SE ADDR�SSF-S PER REQUY- . <br /> Z_ PUBLIC I 1LESlIZECC SDS REVIL-1'J .ORE BY APPOINTMF_NT Oti'LY. APPOINTMENTS ARE - <br /> ARI %NGED BY CALLING (:09)463-034o. . OFFICE HOURS FOR APPOItiT�llsi�TS ARE S. 1.TO ED <br /> MONDAY THRU FRIDAY E,(CLUDI:NG HOLIDAYS, 8:00 A-M-TO 13:00 ;NOON AND 1:00 P. 1. TO S:SO <br /> P.M. <br /> 3. A PU13IIC KL-CORDS�LEASB A.PPLCATION AKD A •' '`2- ' 'DABLE DEPOSIT/ RE <br /> IS REQUIRED. DEPOSITS ''+1•�II i BE RETURNED TO THF- APPLICANT IF T14E nLESRECORDS ARE <br /> RE <br /> OF RE <br /> NOT AVAII A-RI-6 WITHIN THE CUSTODY dF THE END. <br /> 4, TIDE ABOVE IDENT3FIED DEPOSIT IS APPY1ED TOWARDS THE TOTAL FILE REVIEW FEE r <br /> CH,�-RGE. T14F BALAuNCE OF SHE CHARGES ARE DUE AND PAYABLE PRIOR TO REVIEWING THE <br /> DOCUMENT(S). <br /> 5. PUBLIC FILES/RECORDS NOT RETURNED IN THIS SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHD STAFF AT THE.EXPENSE OF THE APPLICANT. "11CIS ADDITIO:�tAL. <br /> SERVICE BE BILI-ED TO THE APPIICANTFOR PAITiETIT. <br /> E- N <br /> 6_ ORIGINAL PUBLIC )=il-S/R.ECOIiDS SHALL NOT BE REJMOVED FROM THE END PRZ.WSES. <br /> SIGNATURE OF AFFIICANT s e. P ,, DAT& <br /> SIGNATURE OF RF_.LEASING OFFICIAL DATE <br /> f EM 00 14 (REV 12/92) <br />