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I trl'1/-1��1b M .�IHM1I 1'Kl.��ur_ i`+�+ ��J �'-w+ u•r'� � 'W' <br /> SAN JOAQUIN COUNTYy2-- <br /> ruouC HEAL111 SUMCES <br /> FNVIRONNIE.NTAL HEALTH DIVISION <br /> PU1tI.TC RECORDS RELEASE APPLICATION <br /> r% ''tu( - £ PHONH NO <br /> r %M <br /> APP1.]CANT ' C <br /> ADDRESS 1805_W. �a LANb �-1�2nshzs+ PHONH NO 41.1E S'/Lo <br /> AGENCY NAME-TAI-t-40 <br /> ADDRESS <br /> PJL�I1BIfl?Itl+.�� <br /> �----- - <br /> TIJIS NC"11C13 IS SOBJ"TAI•II TI; DIV18fON (F};D}POLUCY B91-0O?.IORDINANCE CODE OF SAN <br /> SGRV5S'A'1'E WATER CODE, <br /> JOAQUIN COUNTY, EIID FFE.S, AND SERVICE CHARGE RESOLIITJONS, <br /> OOVERNMEN'f CODE AND 111E EVIDENCE CODE. <br /> A MAXIML161 OF 1'Etl (10)PREMISE ADDRESSES PER REQUFSr. <br /> 2_ Pt101�C YILL•S/RECORDS REV;[_W ARF. RY APJ'O IU.N!-3 ADPOItJTA1EN('S ARE <br /> nRRANOED BY Ca;-Ii NU (279)J68-03aU. OFFICE IIOURS FOR APPOtNITiEN'fS ARE SCI;L•D�ILE <br /> MONDAY THRU FRIDAY EXCLUDINO HOUDAYS, 8:00 A.M.TO 12:00 NOON AND 1:00 P.M. [0-3;30 <br /> P.M. <br /> 3. A P1.30C]O RF.CURUS RELEASE API'I.ICKIION AND A NON-RFPUNI) I1L DL•POSIT ON 578.00 <br /> 1.11, REQUIRED. CUE <br /> DEPOSITS WWIL RE RE`IU OF TO T TIIE APPLICANT IF'nIE FILES/RECORDS ARE <br /> NOT QUAVEREDrODy <br /> 4, TIIF. ABOVE IDENT1Fi1P.DEPOSIT' IS APPIIED TOWARDS THE TOTAL FILE REVIEW FEE <br /> CIIARGE. '111F BALANCE OF i-RS CIIARGIS ARE DUE AND PAY ABLEZRIQ TO REVIEWING TME <br /> DOCUNIENT(S). <br /> 5, PUBLIC FILES/RC:CORDS NOT RETURNED IN 111E SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EIID SCAFF AT 111E EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICF. WII.I.HB BIIi.ED 1Li 7HE APPLICANT AOR PAYMENT. <br /> (>, ORItiINAL YUBUC FILFSIRECORDS SHALL NOT BE REMOVED FROM TIIE F11D PREMISES. <br /> �! DATE /C70771�_ <br /> SIGNATURE OF AM-ILANT <br /> SIGNATURE OF RELEASING OFFICIAL <br /> DATE —V <br /> pit 00 14 (REV IV92) <br />