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'r�'d �C101 <br /> • SAN JOAQUIN COUNTY • <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT <br /> ADDRESS bP PHONE NO Z? ------,c�� <br /> AGENCY NAMES <br /> ADDRESS_ [2 I L Yyj(D t y-) <br /> 121,E ADDRESS <br /> FAD AGENCY PATE <br /> rt�� a n <br /> F. Frept76 5� ENS&7/-17> <br /> _-2/ UT FFrnrnnrt t St <br /> /- ' r--c <br /> / ) 1, F,lhzr <br /> t7`! Si ee V <br /> ED <br /> r 6 V <br /> a <br /> / C` ( Q PUBLIC HEALTH SCE VI Y <br /> LINIVIRUMMENTAt-NEAL <br /> THIS NOTICE IS SUBTECI TO THE REQUMEMENTS, IDENTIFIED IN THE PUBLIC HEALTH <br /> SERb10ES/ENVIRONMENTAL HEALTH DIVISION(EFTD)POLICY M -oo7, ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EAD FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1- A MAXIMUM OF TSN (IO) PREMISE ADDRESSES PER REQUEST. <br /> J 2• PUBLIC MLESMECORDS REVIEW ARE BY lEE y <br /> ARRANGED BY CALLING (209)46g_040- APPOINTMENTS ARE OFFICE HOURS FOR APPOINTMENTS <br /> MONDAY TXPU FRIDAY tXCLUDING HOLIDAYS, HO A.M. TO 12 00 NOON ARE <br /> SCHEDULED <br /> ED <br />- P.M. <br /> A PUBLIC RECORDS RELEASE APPLICATION AND A NON-REFUND Er F � <br /> IS REQUIRED. DEPOSITS WILL, BE RETURNED TO THE APPLICANT IF THE FILFS/R_SIT 0 <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE EUD. <br /> 4• THE ABOVE IDENTIFIED DEPOSTT 1S APPLIED TOWARDS THE TOTAL FILE REVIEW FEE <br /> CHARGE. THE BALANCE OF THE CHARGES <br /> DOCUMENT(s) Q� s t ARE DUE AND PAYABLE MO TO R <br /> hcur. EVIBWLNO TETE <br /> 7a// �ti I`.F <br /> PUBLIC PILES/RECORDS <br /> CORRECTED BBY THE NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILT,BE <br /> CEFID STAFF AT THE EXPENSE OF THE APPLICANT'. TRIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE AFFUCANT FOR PAYMENT. <br /> 6' ORIGINAL PUBLIC FI BMECORDS SHAM.NOT BE REMOVED FROM THE ERD PREMISES. <br /> SIGNATURE OF APPLICANT - <br /> DATE <br /> SIGNATURE OF RELEASING OFFICIAL <br /> PH OO 14 (REV 12/92) DATE <br /> y <br /> Za'd GOS£9£9T 01 wnN4 WHcb'Ca CCrT-).T-PS <br />