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�E�1V ,►VA U1Pl 4VU[V1'X �'`�'` . . f . .'W <br /> PUBLIC HEALTH SERVICES <br /> Err�lxo� TN'rAL HEALTH DIVISIC14 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> • APPLICANTD �e. Assoc. . - 2), * Sa��PfIONB NO — <br /> ADDRESS `v4 Ty gNy4 i E pKc/.*tG - joo s. 8cc.t-t,i.4-i _ L� <br /> AGENCY NAME PHONE NO <br /> ADDRESS v o u o <br /> i9/Q.iss c da.� C A q St� <br /> PRE ADDRON Arc. die CA LAAD AGENCY DATE <br /> WO TA SCA-l"14^1 "di- Nwr r"/6.r hemk ,oto vs� <br /> X,57/ X, L-, c Avv ,Kra _L am^ Go sG <br /> _ #' A. Pim gf- <br /> &46#® 4olle- L _CSL-Pl-T, <br /> 22S' Cb��E.Gc. �9rrc 1 uS'1' <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> • SERVICES/ENVIRONMENTALHEALTH DIVISION(EHD)POLICY#92-007,ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, RHD FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1. A MAXIMUM OF TEN (10)PREMISE ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILES/RECORDS REVIEW ARE BY AMQl TMENT-_ONLY. APPOIN'T'MENTS 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 RUEASE APPLICATION AND A ICON-REIRM A LE DEPOSIT OF$78.00 <br /> IS REQUIRED. DEPOSITS WILL BE RETURNED TO THE APPLICANT IF THE FILM/RECORDS ARE <br /> NOT AVAILABLE WITHIN TNB CUSTODY OF THE EHD. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS 'THE TOTAL PILE REVIEW PEE <br /> CHARGE, THE BALANCE OF THE CHARGES ARE DUB AND PAYABLE PRIOR TO REVIEWING THE <br /> DOCUMENT(S). <br /> 3. PUBLIC FILES/RECORDS NOT RE11IRNED IN THE SAME CONDITION AS RECEIVED WILL.BE <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILLaS/RLCORDS SHAM,NOT BE REMOVED FROM THE EHD PREMISES- <br /> SIGNATURE SIGNATURE OF APPLICANT <br /> a DATE <br /> • SIGNATURI?OF RELEASING OFFICIAL, DATE <br /> EH OO 14 (REV 12/92) <br /> I ri i i7r <br /> s <br />