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I /n ) u iu- i�.'i .�: iorm rrc /••.� i�u Gni �O VJi CVJ _. P. ] <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> FINVIRONMFNTA.L HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT A fl1j ttli1 PRONE NO ��tP <br /> ADDRESS 61 ./ <br /> AGENCY NANIH 1p T� PFIONE NO <br /> ADDRESS <br /> kILE ADDRP.S.S LEAD AGENCY DATE <br /> � ►a r( rr �r Mn!N s Nb9Pa,alt <br /> 'nils NOTlc12 l5 SUIUECr TO TIIE REQUIREMENTS IDENTIFIED IN TILE PUBLIC HEAL-m <br /> SGRVICES/ENVIRONMEN'PAI.HF.AI_TH DIVISION(FHD)POLICY"2-007,OROWANCE CODE OF SAN <br /> JOAQUIN COUNTY, EiID FEES AND SERVICE C14ARGE RESOLUTIONS, STA'L'E WATER CODE, <br /> GOVERNMENT CODE AND'0113 BVIDENCE CODE. <br /> 1. A MAXIMUM OF TEN (JO) PREMISE ADDRESSES PER RC•QUEST. <br /> 2. PIIMIC FILESIRECORDS REVIEW ARE BY APPOINTT 'NT ONLY, APPOINTMENTS ARE <br /> ARRANGED BY CALLING (209)468 340. OFFICE HOURS FOR APPOINTMENTS ARE SCHkUULEI) <br /> MONDAY'DiRU FRIDAY UCCLUDIN(J k{OLIDAYS, 8:00 A.M. TO 120) NOON AND i:W P.M_ 'f0 4:30 <br /> P.M. <br /> 3. A Pl1BI.IC RE--CORDS RELEASE APPLICATION AND A NON-REFUN )A111_I; DL-.POSIT OF$78.00 <br /> IS REQUIRED. DEPOSITS WILL.. BLS R1:1'URNED TO DIE APPLICANT IF 7H6 FILL•S/RCCORDS ARL <br /> NOT AVAIL ABLP WITHIN THE CUSTODY OF THE 6110, <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE• TOTAL. FILE REVIEW FEE <br /> CHARGE. THE BALANCE OF 114E CHARGES ARE DUE AND PAYABLE PRIORI TO REVIEWING.THE <br /> DOCUMENT(S). <br /> 5. PUBLIC FILES/RECORDS NOT RETURNED IN 771E SAME CONDITION AS RECEIVED WILL Be <br /> CORRECTED BY THE EHD STAFF AT THE IiXPENS13 OF T1413 APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE RETMOVGD FROM TILE EHD PRENU5E5. <br /> SIGNATURE OF APPLICANT DATE <br /> SIGNATURE OF RELEASING OrFICIAL DATE <br /> FII 00 14 (REV 12/92) <br />