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r <br /> SAN JOAQUIN COUNTY <br /> PUBLIC REALM SERVICES <br /> E.NVIRONMEA rA.L HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT Q a 1 L PITONS NO_( 5-7 O <br /> ADDRESS zT <br /> AGENCY NAMB xj33..ksr 6�nvj PHONE NO (Q 4 61 .3 s-7 D <br /> ADDRESS Mao ,,,alpKd 0- G S <br /> F-IIX ADDRESS LXIAD AGENCY PAMW <br /> RA RECC-IVED <br /> _ ,1 a <br /> ( I 1 Ad s {'!��M��A un ull,co Mt <br /> I 1 f 9 L-9; :::ljm ( �A� t�� TtH- <br /> ENVIRaNMEtdrn� HEQty +gfdhl� <br /> cl',25zi ::&nraAho tC/, %,JLNv <br /> 9"93 <br /> - - 4I►Iv COUNTY <br /> ENVIRONMENTAL tiFei '"VI <br /> H 01 SIGN <br /> --- <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEAI:TH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION(EHD)POLICY#92-007, ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EHD FEES AND SERVICE CHARGE 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 FILESMECORDS REVIEW. ARE BY APPOINnaNT ONLY. APPOINTMENTS ARE <br /> ARRANGED BY CALLING (209)468-4340. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br /> MONDAY THRU FRIDAY EXCLUDING 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-REFUNDABLB DEPOSIT OF$78.00 <br /> IS REQUIRED. DEPOSITS WILL BE RETURNED TO THE APPLICANT IF THE FILES/RECORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE MID. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE "VIEW FEE <br /> CHARGE. THE BALANCE.OF THE CHARGES ARE DUB AND PAYABLE PRIOR TO REVIEWING T41E <br /> DOCUMENT(S). <br /> 3• PUBLIC FILESIRECORDS NOT RM RNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORR6C'IW BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BB REMOVED FROM THE EHD PREMISE'S. <br /> SIGNATURE OF APPLICANT DATE O <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> Lill 00 14 (REV 12/92) -- x <br /> T 1 1...-J r"I r r T <br />