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1 <br /> 1 :30P11 FRC DV ANCF-D GEOENV I ROl M 209 467 11 <br /> SAN JOAQUIN COUNTY 1� � <br /> PLIC IIEALTH SERVICES --- <br /> ENyMpNN1ENTAL IIEALTIi DIVISION a p p <br /> - <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> NU 47 <br /> APPLICANT V <br /> QNE <br /> ADDRESS �tJ' 6tllU �! -----PI�ON3 NO_- <br /> A(-jH'NCY NAl E <br /> ADDRESS <br /> E pLOS <br /> T7TT ADDRESS _ <br /> 54g t , " <br /> it !c-c$ Ot� <br /> 'T'IlF PUBUC IAEAL'1N <br /> nRMNANC F CODE OF SAN <br /> l3{1S N()'1'10E IS SUli1L'•Ct 7'O R <br /> 'irtlG L•QU1RL•t,1EN"TS ICCN�IIT'1rD I STATE WATER COP!?? <br /> JOAQUIN CNVNTY4^�iD FEES ANO SERVICE CHARGEIJCy RESOtIONS. <br /> JOAQt11N COU <br /> GOVERNNLENT CODE AND THE EVIDE14" CODIs. <br /> I, A MAXI�NIUM OF TETJ (10) PR2=!~iISI3 ADDRESSES PER REQUEST• <br /> MENT3 <br /> Pligl_IC' E-lI.ES/Rf.cGRI)S RF.VIL-W ARE BY �1 �Sr11____T p1�1 �PP()t11"1SCRED2. ARI) <br /> ARRANGED BY CALLING (7�Ia68NUjj OFAYS 800 ASM TO t2:00 FOR 1NOON AND 1K00 p.Ni. 4,30 <br /> NIONDAY THRU FRIDAY I�iC.LUDINI} fiVUI�A <br /> P.M. <br /> 3. A PUBLIC RECORDS RELEASE A1'I'IJCA'TION AND A NON-R EIVI A13 I - DI;POSI'Cor 578.00 <br /> IS REQUIRED. DF-POSITS WILL 3C R ED To ']-Il <br /> �?PUCANT IF Tli FILF-S/RECORDS ARL <br /> NOT AVAILABI,� WITHIN T1413 CUSTODY OF <br /> OTAL <br /> 4. LE REVIEW FEE <br /> TI[E .ABOVE IDENTIFIED DE-POSIT IS APPLIED TOWARDS <br /> 1)YAYABLE Px ()K'rOIREV'EWING THE <br /> CHARGE, THE BALANCE OF THE CHARGES <br /> DOCUbIENT(S)- <br /> VED WILL BE <br /> 5. PUBLIC FILESIRECORDS NOT RETURNED <br /> IN TII S THE APPL ICAN"i s THIS 1 ADDITIONAL <br /> CORRECTED BY 'IRE EHI) STAFF AT THE <br /> SF�RVICE WILL BE BILLED TO RIE APPLICANT FOR PAYMENT. ONt <br /> "CORDS SHALL NOT BrR <br /> E RE1rI0VED <br /> 6, ORIGINAL PUBLIC PILES/ <br /> THE l:IID PREMISES. <br /> _ DATE <br /> SIGNATURE OF APPLICANT <br /> u� DATE <br /> SIGNATURE OF RELEASINGOFFICIAL._ . <br /> EH 00 14 (REV 12197) <br />