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PURLIc IIF,ALTH 5FRvwvs <br /> F IRONn4.>:,NTAL HEALTH DIVIS i <br /> FtJfltfC RECORDS RELEASE APPLICATION <br /> APPLICANTE�,y PHONE NO SSI- ) S2 L - S 1Tr, <br /> ADDRESSACC 5,,, -q lle /Ala.-Rd, C /I- 4YS- / <br /> AGENCY NAME _ —PHONE NO' <br /> ADDRESS <br /> a B_ADi)RESSV'// LEAD AGBNCY Am <br /> 1 <br /> �lO� OPy Y/\JQ _- <br /> 2011 lUn�,. '�1(\J2 <br /> r\ <br /> T1ITS NOTICE IS SUBIRCT TO THR REQUIREMENTS [I)FNlTFIFD IN THE PUBLIC HEALTH <br /> SERVtCES/ENVTRONMENTALNEALTTI DIVISION (END) POLtCY b92-M7. ORDINANCE CODE OF SAN <br /> )OAQUIN COUNTY. EHD FPP.S AND SFRVIC13 CIIARGP RESOLUTIONS. STATE WATER CODE. <br /> i GOVERNMENT CODE AND 7116 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)46R-0340. OFFICE HOURS FOR APPOINTMENTS ARE SCIIEDULED <br /> MONDAY T11RU FRIDAY EXCLUDING tIOLIDAYS. 9:00 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 NUN-REPUNDABLE DEPOSIT OF$78.00 <br /> 1.5 REQUIRED. DEPOSITS WILL BE RE11JRNPD TO 211E APPLICANT IF THE FILES/RF-CORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OP THE EMD. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE_ REVIEW FEE <br /> Cl/AROE. TIIR BALANCE OF THE CHARGES ARE DUE AND PAYARL13 PRIOR TO REVIEWING TUE <br /> DOCUMENT(S). <br /> 3. PUBLIC FILES/RECORDS NOT RETURNED IN THP SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EW STAFF AT 111E EXPENSE OF THE APPLICANT. TMS ADDITIONAL <br /> SERVICE WILL BN BILLFD TO TNB APPLICANT FOR PAYMENT. <br /> 5. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT EE REMOVED FROM THE MID PREMISES. <br /> SIGNATURE OF APPLICANT DATE <br /> SIGNATURPOFRFLSASINGOFIICIAL-. _ DATE <br /> F11 00 14 (REV 12/92) <br /> \rJ \ <br /> .'_0'd T£L95980iSt 01 WOdd WHLS:60 £66I-0z-60 <br />