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/�I L—I `J'�0 ,�: 1 Orl•I 1"Rt r�MU4. .�`tem.:. ..,...... v w <br /> SAN JOAQUIN COUNTY <br /> "JELUC HF-"TH SKR%gCFS <br /> ENVIItONNMgTAL HEALTH UlVLSION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT Ilia'cl � 6165' PHONE NO <br /> ADDRESS / <br /> AGENCY%NAMB NO <br /> ADDRESS <br /> F1 A]�DL(BSSLEAD -AQ9YCY <br /> 1711S NOTICS Is St ulECT To TIIG REQU1REMFNTS 1DENTIFIFD IN 'TUE PUBLIC HEALTH <br /> SERVICES/1=NVIRONMENTALHEAI-1'1.1 DIVISION(F.ND)POt.ICY M4307.[IRDINANCE CODE OF SAN <br /> ]OAQL"N COUNTY. E!!D FEES AND SERVICE CHARGE RESOLUTIONS. S1'ATfi WATEA CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> I. A NIAXIMUm OF TEN(jO) PREMISE ADDRESSES PER REQUEST. <br /> 2. P[ffiUC FILES/RECORDS REVIEW ARE BY APPOINTMENT ONLY. APPOINTMENTS ARE <br /> ARRANGED BY CA1.UNGI (204}468-0340. OFFICE HOURS FOR APPOIWMIENIS ARE SCHEDULED <br /> MONDAY'MRU FRIDAY EXCLUDING HOLIDAYS, 11.00 A.M. TO 13:00 NOON AND 1:00 P.M. TO 4:30 <br /> P.M. <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION AND A NC)N-RI=FIlNDAlfljE I)F.Ponr OF Smw <br /> IS,REQUIRED. DfiPOSI'fS WILL 01? R13-URNED lX) '1'1I1 APPLICANT tF THE FII:1WRECORDS AlK4 <br /> NOT AVA.ILABIE WITIUN TH13 CUSTODY OF THE EMD. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEW FEE <br /> CHARGE. THE EALANC6 OF THE CHARGES ARE DUE AND PAYABLE PR 1UR TO REVIMING 711rm <br /> DOCUMENT(S). <br /> 5_ PU8L1C FILES/RECORDS NOT RE-MRNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE END STAFF AT TIME EXPENSE OF THF APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILESIMCORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> 64 <br /> SIGNA'T`URE OF APPLICANT DATE w �. <br /> SIGNATURE OF RELEASING OFFICIAL DATES <br /> EH 00 14 (REV 12/92) <br />