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' SAN JOAQUIN COUNTY • <br /> PUBLIC HEALTH SERVICES _ ;I <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT Q i( O PHONE NO /n <br /> ADDRESS //>'� <br /> AGENCY NAME/71c / >-off/mac.^7�" PHONE O <br /> ADDRESS <br /> lz:�"/e L <br /> FILE ADDRESS <br /> el7 1/Y />r;ve <br /> /1�. uz W �za' Y'u/J S�. eer C�<nc��•�iuu>`�<^ �n� ate, <br /> •'9 w- G , a/-acs- s� ��.ini;• �'or� // <br /> 3 57 7V-z V D/ <br /> / c Con7Zc i x 't•/7 <br /> 4 '1dr�r >n` v L+igY l_ rlT moi' vn,�uior�/1� 1 �Y`L�z z='//Arm <br /> Si�J i>/ /� nt- /i^ GI/ri Y / i J E/�N'� �iOI�G<� Ccs/ , '• • /Ori <br /> Iv <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENV IRON MENTAL HEALTH DIVISION (END)POLICY#92n C40DE OF SAN <br /> JOAQUIN COUNTY, END FEES AND SERVICE CHARGE RESOLU t <br /> GOVERNMENT CODIf AND THE EVIDENCE CODE. JFFiiAN 2 8 994 <br /> 1. A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQVAA OA( IN COUNTY <br /> PUBLIC HEAALTH SERVIOFS. <br /> 2. PUBLIC FILES/RECORDS REVIEW ARE BY APPOINTR't#UM5MWALF{ENbiQWlNVTS ARE <br /> ARRANGED BY CALLING (209)468-0340. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br /> MONDAY THRU FRIDAY EXCLUDING HOLIDAYS, 8:00 A.M. TO 12:00 NOON AND 1:00 P.M. TO 4:30 <br /> P.M. <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION AND A NON-REFUNDABLE DEPOSIT OF$78.00 <br /> IS REQUIRED. DEPOSITS WILL BE RETURNED TO THE APPLICANT IF THE FILES/RECORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEW FEE <br /> CHARGE. THE BALANCE OF THE CHARGES ARE DUE AND PAYABLE PRIOR TO REVIEWING THE <br /> DOCUMENT(S). <br /> 5. PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF TILE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> SIGNATURE OF APPLICANT / DATE ` <br /> \�� <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 12/92) <br />