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!> / SAN JOAQUIN COUNTY <br /> 4` FUBLIC EjFA_LTH SERVICESi- <br /> ax "_ ENVIRONMFr�iiAl FALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> PROM NO (om) <br /> a .. APPLLCAPIrVGI1dGr - <br /> frr . ADDRESS <br /> AGENCY NADffi dJuu�ttd tjepE/N��hMK�t�I ( PHONE NO S00Y £ <br /> ADDRESS HOO <br /> F <br /> i <br /> ; n anRl=ss i rAD AGENCY DATE <br /> n <br /> 3909 N. (fit ! anei -_EHD {`�� 42D�r 917 <br /> -'{TIRO West l,aag_ <br /> d Ave <br /> f(025 Coronado Ave 1 <br /> _3755N t <br /> 1 ocn 6" St S <br /> f4 Z(e ��rSm+ St LIS <br /> (438 ��rSonSt' it � <br /> �x <br /> 71i1S NOTICE 15 SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTA..HEALTH DIVISION (EHD)POLICY 092-007.ORDINANCE CODE OF SAN <br /> )OAQUIN COUNTY, EILD FEES AND SERVICE CHARGE RESOLUTION'S, SPATE WATER CODE <br /> ' GOVERNMENT CODE AND THE EVIDENCE CODH- <br /> al <br /> A MAXIMUM OF TEN (10)PRE'�iISE ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILES/RECORDS RfiVIEW ARE BY APPOINTMENT,ONLY. - APPOINTMENTS ARE <br /> '`•�+ ARRANGED BY CALLING (:09)468-0344. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br /> a, MONDAY D 13Y FRIDAY (M;)4DINO HOLIDAYS, 8:00 A.M. TO 12:00 I;OON AND 1:00 P.M_TO 430 <br /> 3. A PUBLIC RECORDS RELEASE A-PPLICATION AND A ,\,ON_gFFUNDADLE DEPOSIT OF$78.00 <br /> 1S REQUIRED. DEPOSITS RILL BE RL'TURI.ED TO THE APPLICANT IF THE FILES/RECORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD_ <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIFD TOWARDS THE TOTAL FITS REVIEW FEE <br /> CHARGE. THfi BAI,VtiCE GF T1IE CHARGES ARE DUE AND PAYA13L E PRIO TO REVIEWING THE <br /> `= DOCUMENT(S). <br /> S_ FUBLIC FILbS/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIV ED WILL BE ; <br /> CORRECTED BY THE P14D STAFF AT THE EXPENSE OF THE APPLICANT THIS ADDITIONAL f <br /> SERVICE WILL BE BLI I TO THE APPLICANT]y)R PAYMENT. a <br /> ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THBEHD PREMISES i� <br /> 3 <br /> ' - <br /> DATElL� <br /> SIGNATURE OP APPLICANT <br /> �1 1.,�1, .�"lJn/ DATE <br /> - SIGNATURE OF RELEASING OFFICIAL , <br /> "; EH 00 14 (REV 12192) <br />