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SAN ,SOA UIN COUNTY <br /> - <br /> PUBLIC HEALTH SERVICES <br /> ENVIR()IVNjpjTAL HEAi,'I"Ii DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCANT I <br /> � IES- PHONE No AGI -32- SCSI <br /> ADDRESS PHONE NO <br /> AGENCY NAME Ey TEG14 Enl v rZC li <br /> ADDRESS <br /> FILE RFS <br /> LEADQUE iCY <br /> Fo r'_T 0—, $TO C KTG nJ <br /> A <br /> E R <br /> pa <br /> JOAQ� <br /> VVIR EALTH SE <br /> TAi rr�Dry <br /> BUC HEALTH <br /> TMS No TICS IS SUBJECT TO THE REQ AHD POLICY+1r4ENTS 21-00�, ORDED IN INAN PU <br /> E CODE OF SAN <br /> SERVICES/EN�LONMEATTALHBAI-TH DIVISION <br /> JOAQUIN COUNTY, E14D FEES AND SCE ODE HUGER OLUIIOI`iS, STATE WATT GODS, <br /> (3ovERNMENT CODE AND T14E EVIDEN <br /> I- A MA)CIIMUM OP TEN (10) pREMISE ADDRESSES PER REQUEST- <br /> 2. PUBLIC FILEV ECORDS REVIEW ARE BY TMENT ONLY. APPOINTMENTS ARE <br /> ARRANGED BY CALLJNG (209)46"340.HOLIDAYS. 8:00 AA M TOA APPOINTMENTS <br /> TS ARE P.M. ULED <br /> MONDAY THRU FRIDAY EXCLUDING <br /> P.M. <br /> 3. <br /> .M- <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION AND A NoN-REFUNDAM I)EPOSIT OF?$78.00 <br /> IS REQUIRED, DEPOSITS WILL BE RETURNED TO THE APP11CANT IF THE FILES/RECORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. <br /> 4, THE ABOVE IDENTIFLED DEPOSIT IS APPLIED 'TOWARDS THE TOTALFILE <br /> REVIEWING THE <br /> CHARGE. THE BALANCE OF THIS CHARGES ARE DUE AND PAYABLE <br /> DOCUMENT(S). <br /> 5. PUBLIC FILESJRECORDS NOTT THE �RETURNED lq ENSU OFSAMEE Appy CONDITION�AS RECEIVED WILL 13B <br /> .�S ADDITIONAL <br /> CORRECTED BY THE EHD STAFF , <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILESMECORDS SHALL NOT BB REMOVED FROM THE EHD PREMISES. <br /> SIGNATURE OF APPLICANT ? C�"As�---- <br /> DATE � a� <br /> �9 <br /> SIGNATURE OF RELEASING OFFICIAL _ _ _ DATE <br /> EH 00 14 (REV 12/92) <br />