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SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT "r.. t t \. PHONE No <br /> ADDRESS 1lIC vie, r �-)- �s«\o.� Cry c z ' / Sri -3 c�-7 <br /> AGFNCY NAME_ 53 zc <br /> PHONE NO Zc-i / 1 <br /> ADDRESSj: '6- 2S,��c vM�U..� •tel <br /> EU ADDRESS LHAD AGENCY <br /> DATE <br /> `te i ,�..- 11•:..,,.,,��- L-n S Fc, y_J - P 1+S (=H IJ <br /> 11it Z w. r1c.w �,.�c L..r c1 Flo FIS C 1"4U <br /> a <br /> -1641 Pyr rl 4 e 5 �c k Gc — �_N\S oao 17 <br /> cA\1C <br /> IJ <br /> PJAYMEN <br /> l F+ n <br /> SE <br /> PUBLIC HEALTRVICES <br /> ISION <br /> THIS NOTICE IS SURMCT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SBRVICBS/ENVIRONMPNTAL HEALTH DIVISION(EHD)POLICY x92-W7, ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EHD FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE.AND THE EVIDENCE CODS. <br /> 1. A MAXIMUM OF T•EN (10) PREMISE ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILES/RECORDS REVIEW ARE BY <br /> ARRANGP.D By CALLING AP O�ENT ONLY. APPOINTMENTSARCHED ARE <br /> MONDAY THRU FRIDAY (rj Du(G HOLIDAYS, 8.00 A.M.TO 12 00 NOONICE HOURS FOR APPOINTMENTS 1Rpp P.M. Tp q 30 <br /> P.M. <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION AND A NON-REFUNDABLE DEPOSIT OF$778.00 <br /> IS REQUIRED. DEPOSITS WILL BE RETURNED TO THE APPLICANT IF <br /> NOT AVAILABLE WITHIN THE CUSTODY OR THE END. THE FILES/RECORDS ARE <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEW FEE <br /> CHARGE. THE BALANCE OF 77.18 CHARGES ARE DUE AND PAYABLE PRIOR TO REVIEWING THE <br /> DOCUMENT(S). <br /> S. PUBLIC PILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE BID STAPP AT THE HXP <br /> S -NSE OR THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO TTIE APPLICANT FOR PAYMENT. <br /> 6• ORIGINAL PUBLIC FLLESMECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> SIGNATURE OF APPLICANT -1— � <br /> -�:""""' DATE �3e�V3 <br /> SIGNATURE OF RELEASING OFFICIAL <br /> EH 00 14 (REV 12/92) DATE <br />