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SAN JOAQUIN COUNTY <br />PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />• P'UB C RECORDS RELEASE APPLICATION <br />( <br />PHONE NO �$eD7 3� i 3 �f <br />ADDRESS "Gr = - � S <br />AGENCY NAMENp,27Hiv�� �" E��,�,/f rQacc),v PHONE NO , 5-4,-t <br />ADDRESS <br />AD LBAD AGENC_ Y <br />`loR �K .,� uq.,� 14 Ut C` N <br />1r3YS Ficin ve- <br />AY <br />�C <br />CQuN <br />PLlSLIC SAL HEALTH DIVISION <br />5tnbjtdUne <br />'1 HI5 NOTICE IS SUBTECT TO THE REQUWXMENTS IDENTIFIED IN THE PUBLIC FLBALTH <br />SERVICES/ENVIRONMENTAL HEALTH DIVISION (ERD) POLICY #42.007, ORDINANCE CODE OF SAN <br />JOAQUIN COUNTY, MID FEES AND SERVICE CHARGE RESOLLTI'IONS, S'T'ATE WATER CODE, <br />GOVERNMENT CODE AND THE EVIDENCE CODS. <br />1. A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST. <br />2. PUBLIC FILES/RECORDS REVIEW. ARE BY A.PPOIN„IMM ONLY. APPOINTMENTS ARE <br />ARRANGED BY CALLING (209)468-0340. OFFICE HOURS FOR APPOINTME� ARE SCHWULED <br />MONDAY THRU FRIDAY EXCLUDING HOULDAYS, 8:00 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_-Rlyl?'UNDABLE DEPOSIT OF $79.00 <br />IS REQUIRED. DEPOSITS WILL BE RETURNED TO TRE APPLICANT IF THE FILESIRECORDS 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 0A.LANCE OF THE CHARGES ARE DUE AND PAYABLEPRI TO REVIEWING THE <br />DOCUMSNT(4 <br />5, PUBLIC FILI~S/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 />A. ORIGINAL PUBLIC PMES/RECORDS SHALL NOT BE REMOVED FROM THE EHL) PREMISES. <br />SIGNATURE OF APPLICANT M-�� DATE _ 1 II 2, <br />SIGNATURE OF RELEASING O(;�IAL T DATE <br />EH 00 14 (REV 12192) <br />CT'--'rr-0-1 T/T 1 .�•IJ l...�� .+^r. ..TT nT A: M <br />