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1 4��ltf—I�J`J'b b:kl/KM I'K�Hlat Nl. cei� yoo v]/eiu • r^.-G. <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> F.NV[RON1V[ENTAL HEALTH DIVISION <br /> )/PUBLICC RECORDS RELEASE APPLICATION <br /> APPLICANT/`�J /14 ; ?r- PHONE NO <br /> ADDRESS lg!z� gAes5�:_ A 3acf/,�f=J0 S7cT�7 <br /> AGENCY NE NO <br /> ADDRESS <br /> .FILE ADDRESS I PAD A QENCY DAry <br /> 0 W 1 -e'er S-r <br /> Irot7 v0 <br /> ri4Lt '�OC�irr;Yl�-�' j' M <br /> 77ilS NOTICE 15 SUWECT TO 171E REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTALHEALTH DIVISION(FlID) POLICY1V924)07. ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EHD FEES AND SERVICE CHARGE RESOLUTIONS, SPATE WATER CODE, <br /> GOVERNMENT CODE AND THB.EVIDENCE CODE. <br /> I. A MAXIMUM OF TEN (]O) PREMISE ADDRESSES PER REQUEST. <br /> 2. PtiBIJC FII.ES/RECORDS REVIEW ARP BY AEPOINT,MENT ONI-Y. APPOINTMENTS ARE <br /> ARRANGED BY CALLING (209)968-0340. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br /> MONDAY THRU FRIDAY IMCLUDING HOLIDAYS, 8:00 A.M. TO 12:00 NOON AND 1.00 P.M.lb 4:30 <br /> P.M. <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION AND A NON-REFUNDIA fI.N DEPOSIT OF 518.00 <br /> IS REQUIRED. DEPOSITS WILL BE RMURNED TO T7iE APPLICANT IF T14E FILES/RECORDS ARC <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEW FEF <br /> CHARGE. THE BALANCE opTHE CHARGES ARE DUE AND PAYABLE PRIOR TO REVJEWING THE <br /> DOCUMENT(S). <br /> 5. PUBLIC FILFS/RECORDS NOT RETURNED IN T1iE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE FHD 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 SHAH,NOT BE REMOVED FROM THE EHD PREMISES. <br /> SIGNATURE OF APPLICANT DATE <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> El 100 14 (REV 12/42) <br />