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f'Pttt„M•! A9t7L. 1 YlJ cad.:+ ..suV'v•a+ad -._-, .r / ... rr <br /> SAN JOAQUIIN COUNTY <br /> PUBIAC JJEALTH SERVICES ll97 — /3 !3 <br /> ENMONAWNrAL HFALM DI[VISXON <br /> pUBLICR.ECORDS RELFASE AF]PLICCATION <br /> APPLICANT Yi t �1 t'1 pHQI�IH rjp <br /> ADDRESS <br /> AGENCYNAME <br /> FrtVDYoYI M jd a . PHONI`? NSC} `� lr'6•"O.Z 6�-fg--�— <br /> ADDRESS t'$®� DAIR <br /> Vt/. Mart Ln Szt S�oCfl�Qt.r <br /> FILB ADD4.D AGENCY <br /> -- <br /> 3q3 t A/*w7o_n._ Rdacd__�._. <br /> THIS NOTICE IS SUBJ.11 ECT TO THS REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION(EHD)POLICY#92.007,ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EHD FEES ANA SERVICE CHARGE PMOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THS EVIDENCE CODE. <br /> I. A MAXIMUM OF TEN (10)1c'RENUSE ADDMSES PER REQUEST. <br /> 2. PUBLIC FILES/RIGCORAS REVIEW ARE. BY A-PFOINT'k4£NT ONLY. APPOINTMENTS ARE <br /> ARRANGED BY CALLING (204)468-0340- OFFICE HOURS FOR APPOINTWIENTS ARE SCHEDULED <br /> NIONDAY THRU FRIDAY EXCLUDING ROLIDAYS, 5:00 AJd.TO 32.00 NOON AND 1.00 P.M. TO 4:30 <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION AND A NON.Rlr-U ' ABLE DEPOSIT OF$78.00 <br /> IS REQUIItTA• DEPOSITS Rr1LL BE REl[URNED TO T149 APPLICANT IF THE FILES/RECORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE EMD. <br /> LE <br /> 4. THE ABOVE 1DENTIFIED THE EPOSIT IS CHARGES ARE D�AND pAYABLH FRIOTOIItIrVIfi�v1NG THE <br /> FEE <br /> CHARGE. THE BALANCE OF <br /> DOCUMENT(S)- <br /> 5. <br /> OCUMENT(S)- <br /> rx" PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORR9CT'ED I3Y THE EHD STAFF AT THE SENSE OF THE APPLICANT" THIS ADDMONAL <br /> SERVICE WILL BS BILLED TO THE,APPLICANT FOR PAYMENT. <br /> b. ORIGINAL PUBLIC FILES/RP-CORDS SHALL NOT BE REMOVED FROM THE EHD SES. <br /> SIGNATL419 OF APPLICANT t DATEDATEU j 1_1 j <br /> �- <br /> SIGNATURE OF RELEASING OFFICI J .c_ — <br /> EHE 00 14(REV 12192) <br />