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J_. <br /> I - SAN JOAQUIN COUNTY COIL �-ry` <br /> 171MLIC T EALTH SERVICES <br /> ENVI:RON11'EFF.I,NAL HEALTH DMSION <br /> PUBLIC CORDS RELEASE APPLICATION <br /> •ts2 'LN r2 SO A <br /> APPLICANT PHONB NO — �j <br /> ADDRESS 0e l SCS 1? 5--.. <br /> AGENCY NAIAE PHONE NO <br /> ADDRESS <br /> w; <br /> FIZ.B ADDRPS LZAD ,t4tENCY I?ATi3 <br /> Union00 L" U <br /> • CP �- '• �3 a <br /> ® rt Jim <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICESIEN4IRONMENTAL HEALTH DIVISION(.EMD)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 /> l. A MA)dMUM OF TEN(10) PRS13SE ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILES/RECORDS REVIEW ARE BY APPOINTA4ENT Q=. APPOINTMENTS ARE <br /> ARRANGED BY CALLING (^.09)468-0340. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br /> MONDAY THR.0 FRIDAY EXCLUDING HOLIDAYS, 8:04 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-REFUNP_ADJ E DEPOSIT OF 578.00 <br /> IS REQUIRED. DEPOSITS WILL BE RHDJRVED TO THE APPLICANT IF THE FILES/RECORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. <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 F910 TO REIVIE ING THE <br /> DOCUMENT(S). <br /> S- ' PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL 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. <br /> S. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> SIGNATURE OF APPLICANT _ DATE <br /> In <br /> SIGNATURE OF RELEASING OFFICi m1p DATE -H,, <br /> EH 00 14 (REV 12192) <br />