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SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT--Ta! RvrFrIRFlz o' ircvr rq� [ur77 PHONB NCP 9e 6W 61y - 3S7O <br /> ADDRESS 606 TRiBvTC ;D #101 cA01'gmtTtTo cA 9ti SIS <br /> AGENCY NAME F.loRrN I.lr-�,RO,o�J N L PHONE NO tlor^L <br /> ADDRESS tcrn�_ <br /> FILE ADDRESS LEAD AGENCY DATE <br /> 1-DI FAST- coag-fEAylA`/ Au-� /-o-r I'lirm Mor cur,= <br /> —PH 1_AST CwA2T (L WAY _Lop 3 IB 9l <br /> I IIS HArT Pip ST2Fi-i _ L. N Nor lot 7) <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICESIM-4NMONMENTALHEALTH DIVISION(EHD) POLICY,492.007, ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EHD FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1• A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST: <br /> 2. PUBLIC FILES/RECORDS REVIEW ARE BY APPOINTMENT ONLY. APPOINTMENTS ARE <br /> ARRANGED BY CALLING (209)4680340. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br /> MONDAY THRU FRIDAY EXCLUDING HOLIDAYS, 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-REFUNDABLE DEPOSIT OF$78.00, <br /> IS REQUIRED. DEPOSITS WILL BE RETURNED TO THE APPLICANT IF THE FILES/RECORDS ARE <br /> NOT AVAILABLE WITH N THE CUSTODY OF THE EHD. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEW FEE <br /> CHARGE. THE BAIANC$ OF THE CHARGES ARE DUE AND PAYABLE TO REVIEWING T14E <br /> DOCUMENT(S). <br /> 5. PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECLED BY THE ERD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> I <br /> SIGNATURE OF APPLICANT / f !/ _ DATE <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 12/92) <br /> ♦nJ _ nr`r_.-,]']T�^ ,ter rrn..IJ I_ln...nn nC�T...-T_^n <br />