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SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> �J ( ENVIRONNIENTAL IMALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT' .11n� R2CN �� PHONB NO J�? 331 �gS/ <br /> ADDRESS �- <br /> AGENCY MANIA El'nT Eri v PHONB NO <br /> ADDRESS <br /> , <br /> ME— ADDRESS LEAD AG�3NCY DAM <br /> -- FOR-T -r' STOCK-Toi\J <br /> ri A <br /> Pp <br /> JOAQU <br /> NyIR(��►�►TAL EALrH SE <br /> N Qlv <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTALHEALTH DIVISION(EHD)POLICY#92-OD7,ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EHD FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> I. A MAXIMUM-OP TEN (10) PREMISB ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILESIRECOR.DS REVIEW ARE BY &EWNTMENT ONLY. APPOINTMENTS ARE <br /> ARRANGED PY CALLING (209)468-0344. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br /> MONDAY THRU FRIDAY EXCLUDING HOLIDAYS, 8:40 A.M. TO 12:00 NOON ANT) I!M P.M. TO 4:210 <br /> P.M. <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION AND A NON-REFUNDABI.>:DEPOSIT OF$78.00., <br /> IS REQUIRED. DEPOSITS WILL BE RETURNED TO THE APPLICANT IF THE FILBS/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 PRIOR TO REVIEWING THE <br /> DOCUMEN IIS). <br /> s. PUBLIC FILESIRECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED 13Y THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. TMS ADDITIONAL. <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMBNT. 4 <br /> 6. ORIGINAL PUBLIC FIL.FS/RECORDS SHALL NOT BE REMOVED FROM THE EHD PRENUSES. <br /> SIGNATURE OF APPLICANT tir Cdi DATEZ93 <br /> SIGNATURE OF RELEASING OFFICIALDATE <br /> EH 00 14 (REV 12/92) <br />