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bALN JILMQUIN COUNTY _. . <br /> PUBLIC MULTH SERVIC7 <br /> 4'-e�ONMENTAL H ALTH <br /> PUBLIC RECORDS RELEASE APPUCA nON - -- <br /> APPLICANT 5 �}'' [grw,; £�lcoa �}sslcs PHONE NO <br /> Qr J SQC 0. C 4 r <br /> AGENCY NAME PHONE 140 <br /> ADDRESS <br /> r, <br /> EMS <br /> LEAD AgENCY <br /> as a <br /> �� S ti5ac3rA- TMLNT <br /> i!g ---RMEI ED <br /> 2?11 No Y LA ;vim DEC 0 2JEM <br /> C°^�J�QL}IN Cpi lwTy <br /> SS PUBLIC HEALTH SERVICES <br /> LLI'VIKUMMENTALH <br /> IMS NO'ITCE IS SUWECT TO TETE REQUIREMENTS IDENtMM IN THE PUBT,.IC HEALTH <br /> SERVICESIENVTRONMISNTAL kMALTH DIVISION(EHD)POLICY#42-007,ORDINANCE CODE OF SAN <br /> JOAQUTN COUNTY, EHD FEES AND SERVICE CHARGE RESOLtMONS, STATE WATER COBE, <br /> QOVERNMENT CODE AND THE EVIDENCE CODE <br /> i. A MAXIMUM OP TEN (10) PREMISE ADDRESSES PfiR RI3QUES'I: <br /> 2. PUBLIC PILBS/RECORDS REVIEW ARE BY A MnMd= gMtX. APPOINTMENTS ARE <br /> ARRANGED BY CALIYNG (209)4,68.4340. OFFICE HOURS FOR APPOIN•TMEaM ARE SCHEDULED <br /> MONDAY THRU FRIDAY EXCLUDING HOLWAYS, 8:00 A.M.'rO 12:00 NOON 7P►ND I:00 P:M.TO 4:30 <br /> P.M. --- <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION AND A MM-RMMM-Abjr;DEPOSIT OF MOD <br /> IS REQUIRED. DEPOSI'T'S WILL BE RETURNED TO ?HIy APPLICANT IF THE FRM/RECORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE FWD. <br /> 4. TRIS ABOVE IDEM MED DEPOSIT IS APPUED TOWARDS TIM 'TOTAL PIS REVIEW FEE <br /> CHARGE. THE BAT;ANCE OF THE CHARGES ARE DUE AND PAYABLE :TO REVIE"QVING THE <br /> DOCLTM$N $j, <br /> S. PUBLIC FILRSWCORDS NOT RETURNED IN THE SAME CONDITION AS RECMVED WILL BE <br /> C"CI'I?D By TIM-MM STAFF AT THE EXPENSE OF THIS APPUCANT. THIS ADDMON& <br /> SERVICE WILL BE BILI-ZD TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PLn3Uc PILES/MP-CORDS SHALL NOT BE REMOVED FROM ME EHD PRMUSES. <br /> • SIGNATURE Op AFPIICANT DATE //A _ <br /> SIGNATURE OF RELEASING OFFICIAL <br /> EH 00 14 (REV 12,/92) DATE. <br /> s, <br />