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SIGNATURE OF APPLICANT <br />*.1 11.11111 <br />I <br />C11 <br />\ifFP_P <br /> <br />LO <br />SAN JOAQUIN COUNTY <br />PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT I 111 fi kr dee.- <br />ADDRESS c93 Agavutz__ S-r. <br />AGENCY NAMEEill , PHONE NO <br />ADDRESS <br />"Wallear---•••• <br />a <br />FILE ADDRESS <br />PoILT or: 571-6 04-TOni <br />7.7, 0 (kVA Sai/V6IT6 <br /> <br />LEAD AGENCY <br /> <br />DATli <br /> <br /> PAYMENT ECEIVED SEP 0.10993 SAN JOAQUIN cook?' y <br />Lubst-le-HEALT SEPVICCS ENVIRONMENTAL H <br /> HUILTH DIVISION <br />THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br />SERVICES/ENv1RONMENTAL HEALTH DIVISION (EHD) POLICY #92-007, ORDINANCE CODE OF SAN <br />JOAQUIN COUNTY, MD FEES AND SERVICE CI-IARGE RESOLUTIONS, STATE WA tbR CODE, <br />r3OVERNMENT CODE AND THE EVIDENCE CODE. <br />A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST. <br />PUBLIC FILES/RECORDS REVIEW ARE BY APPOINTMENT ONLY. APPOINTMENTS ARE <br />ARRANGED BY CALLING (209)468-0340. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br />MONDAY THRU FRIDAY EXCLUDING HOLIDAYS. 8:00 A.M. TO 12:00 NOON ANTI 1.00 P.M.TO 4:10 <br />P.M. <br />A PUBLIC RECORDS RELEASE APPLICATION AND A NON-REFUNDABL4 DEPOSIT OP $78.00 N. <br />IS REQUIRED. DEPOSITS WILL BE RETURNED TO THE APPLICANT IF THE FILES/RECORDS ARE <br />NOT AVAILABLE WITHIN WE CUSTODY OF THE Eli!). <br />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 />DOCUMENT(S). <br />PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br />CORRECTED BY THE El-ID STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br />SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br />ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br />4-i-vN a/Lc/VIA DATE <br />SIGNATURE OF RELEASING OFFICIAL_ DATE <br />EH 00 14 (REV 12/92) <br />PHONE NO 0/7 331 50/