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COPY <br /> ' SAN JOAQUIN COUNTY 9y - J 7O <br /> PUBLIC HEALTH SERVICES <br /> ENV][RoNr,WTAL HEALTH DIVISION <br /> PUBLIC REC RDS RELEASE APPLICATION <br /> SU2nne A"&rwn <br /> APPUCANT PHONE NO <br /> ADDRESS • <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> FILE ADDEMS LEAD AGENCY DA <br /> � -5'ibck�3n <br /> R <br /> 00 � <br /> . amme <br /> LiD - �MF <br /> _ � ;t"; .-%ice •- i <br /> i1 1 L <br /> 7 <br /> ua, um ubxr Ptume ? <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICFSIENVIRONMENTAL HEALTH DIVISION (EMD)POLICY 992-007,ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY., E ID FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1. A MA)QMUI.I OF TEN (f0) PREMISE ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILESIRECORDS REVIEW ARE BY APPOINTMENT ONLY. APPOINTMENTS ARE f <br /> ARRANGED BY CALLING (209)468-0340. OFFICE HOURS FOR APPOINTI+JENTS ARE SCHEDULED <br /> MONDAY THRU FRIDAY EXCLUDING HOLIDAYS, ti:00 A.M.TO 12:00 NOON AND 1:00 P.M.TO 4:30 <br /> P.M. 1 <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION AND A NON-REFUNDABLE DEPOSIT OF 578.00 <br /> IS REQUIRED. DEPOSITS WILL BE RETURNED TO THE APPLICANT IF THE FILESIRECORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. <br /> r <br /> 4- THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEW FEE <br /> CHARGE. THE BALANCE OF THE CHARGES ARE DUE AND PAYABLE PRIG TO REVIEWING THE <br /> DOCUMENT(S). <br /> 3. PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE END STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDMONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILESIRECORDS SHALL NOT BE REMOVED FROM THE FHD PREMISES. <br /> SIGNATURE OF APPLICANT DA 2 <br /> SIGNATURE OF RELEASING OFRO DATE <br /> EH 00 14 (REV 12/92) <br />