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• SAN JOAQUIN COUNTY �t J <br /> PUBLIC HEALTH SERVICES <br /> ENVlgONg,NTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT n,, N ' 'leed PHONE NO (91(o)5.0-4 Zz-'Dy <br /> ADDRESS ICV [✓ 3rne✓1t CA - <br /> AGENCY NAME / PHONE NO CQiU oL4�c_�- <br /> ADDRESS i Au 1 °�LOlgal - 7.-7 <br /> FILE ADDRESS_ <br /> LEAD_ A_GENCy DATE <br /> -ZZ Z,:3 lLlll�/r4�n�i[;N No �� S <br /> 7 i ;=z� /tilt✓c1cA �1 /)lri�J�_ No <br /> —7-701 7A0A <br /> ISS Tf1Mr\A�l�wl �� <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION (EHD)POLICY#92-007. ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EHD FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> I. A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILES/RECORDS REVIEW ARE BY APPOIN►MENT ONLY. APPOINTMENTS ARE <br /> ARRANGED BY MONDAY THRU FRIDAY CALLING EXCLUDING HOLIDAYS, 8:00 A M TO�00 NO AND 1:00 P.ARE M. TO 4:30 <br /> P.M. <br /> 9, A PUBLIC RECORDS RELEASE APPLICATION AND A NON 'UNDL DOST OF$78'00 <br /> 1S REQUIRED. DEPOSITS WILL BE RETURNED TO THE APPLICANT IF THE FJLES/RECORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED S THE TOTAL FILE RFvlh* FEE <br /> CHARGE. THE BALANCE OF THE CfIARGES ARE DUE AND PAYABLE PRIOR T REVIEWING THE <br /> DOCUMENT(S). <br /> g. PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHD 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 /> SIGNATURE OF APPLICANT <br /> DATE q- — <br /> SIGNATURE OF RELEASING OFFICIAL <br /> DATE <br /> EH 00 14 (REV 12/92) <br /> 7 <br />