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IULe kj <br /> ®® <br /> FLUOR DANIEL GTI <br /> Jean M. Moron <br /> HydrogeologistS '1 <br /> t y!�/ <br /> •.. <br /> 757 Arnold Drive, Suite D/Martinez, CA 9d553 USA JOAQUIN COUNTY L <br /> (925) 370-3990 FAX: (925) 370-3991 HEALTH SERVICES <br /> E-Mail: imoran@gtionline.com NTAL, HEALTH DIVISION <br /> ru�1,1C REC URDS RELEASE APPLICATION <br /> PLICANT JE,RN MOP-" _ PHONE NO q?-5'- 370 - 3490 <br /> DRI ESS <br /> .�GEN,I CY NAIL / ,;. - i,: ;,_,. ;, PHONE NO <br /> ADDRESS <br /> 1 <br /> t <br /> FUL� ADDRESS BUSINESS NAME/ PROGRAM OR <br /> FACILITY TYPE OF FILE <br /> '".;1 r�l�P <br /> I <br /> I <br /> I <br /> i <br /> ir.#t ##*#*#####ie#ir# k######t'Jc##tf#•t#tf� E##*##*� k# t*f#fdr�r#####f###t�r <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> S!ERVCES/ENVIRONMENTAL HEALTH DIVISION (EHD) POLICY 994-007, ORDINANCE CODE OF <br /> S'AN OAQUIN COUNTY, EHD FEE AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> I <br /> 1'. A MAXIMUM OF TEN jjj0 PREMISE ADDRESSES PER REQUEST <br /> 2'. PUBLIC FILES/RECORDS REVIEW IS BY APPOINTMENT ONLY. APPOINTMENTS ARE PROCESS- <br /> ED I;� CALLING (209968-3420. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED MONDAY <br /> U, <br /> THRFRIDAY EXCLUDING HOLIDAYS, 8:00 AM TO 12:OQ NOON AND 1:00 TO 4:30 PM. <br /> i <br /> 3! A <br /> PUBLIC FILES/RECORDS RELEASE APPLICATION <br /> (PRRA) IS REQUIRED. <br /> 41 PU LIC FILESIRECORDS NOT RETURNED THE SAME CONDITION AS.R <br /> CEIVF> V4LL <br /> BE <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. (SEE EHD POLICY 94- 007) <br /> 5. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> i <br /> +i s+.l...••+++t++i+4•.a+•••++++s••.+IF+++••.••...++a e••••+++++ <br /> .F. <br /> StGNA�TURE OF APPLICANT DATE <br /> I <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00� 14 (REV 9/96) <br />