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`✓ b- -I J`_a/ b:U I pt'l r rlml nuc rn, Lc•. ow o.c. '/ <br /> 9rJ -/3 a <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HEAVIll SERVICFS <br /> ENVIRONNIE.NTAL IIL.ALTII DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> -� <br /> APPLICAN-T � �Cj PIIONENO <br /> ADDRESS?UJ Q mkil <br /> CA quo "7 <br /> AGENCY NAME PHONE NO <br /> ADDRESS ___. <br /> FILE ADDRESS (�^' LEAD AC,LEErM-Y I r DATE <br /> q100 155T /' Amo(rl- <br /> JI <br /> 7711S NOTIi:& IS SUBIECf TO T7iE REQUIREMENTS IDENTIFIED IN 77[E PUBLIC I4F.AL7lI <br /> SERVICESIENVIRONMENTAL HFALTH DIVISION(FIID) POLICY 0921)07,ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EIID FBM AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1. A MAJCIMLIM OP T7-stl (10) PREt,I1SB ADDRESSES PCA REQUEST. <br /> 2. 1,I1611C F1J-r!S/RFCORDS REVIEW ARF BY AG_131ffrM - 1.1 APPOINTMEN"f3 ARE <br /> ARRANGW BY CALLING (209)468-0140. OFFICE HOURS FOR APPOINTI,IEN'I'S ARE SCHE=DULED <br /> MONDAY THRU PRIDAY EXCLUDING HOLIDAYS, 8:00 A.M. TO 12:00 NOON AND 1:00 P.M. (0.4:30 <br /> P.M. <br /> 3. A PUBLIC RECORDS RELEASU' APPLICATION AND A(JON--RE[-UNDAll1_E DEPOSIT M1 778.00 <br /> IS REQUIRED. DEPOSIT'S A,IM BE RETURNED TO THE APPLICANT IF THE F11-GSIRECOR75 ARE <br /> NOT AVAILABLE WITHIN THII CUS'PODY OP THE ITIID. <br /> 4. THE ABOVE IDENTTFif-D DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEW FEE <br /> CHARGE THE BALANCE OP Ii1S CHARGES ARE DUE AND PAYABLE i RIOR TO REVIEWING THE <br /> DOC-UMENT(S). <br /> S. PUBIJC FILES/RECORDSNor RETURNED IN TTIE SAME CONDITION AS RECEIVED WILLBE <br /> CORRECTED BY THE EHD STAFF AT TIIU OCPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC PILES/RECORDS SHALL NOT BE REMOVED FROM THE END PREMISES. <br /> SIGNATURE OF APPLICANT DA1'E _QyL� ^q2�^ <br /> SIGNATURE OF RrMMEASING OFFICIAL L �� DATE u 1 <br /> Ell 00 [4 (REV 12!92) <br />