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12-28-1995 2:55PM FROM AGE NC 209 956 0700 p 1 <br /> SAN JOAQUIN COUNTY <br /> PUBUC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DMSION <br /> KIRLIC RECORDS RELEASE APPLICATION <br /> 4t AAKED CrL o��v;soVlroPn r� L0 <br /> APPLICANT .+ ��it�ln! C PHdNB NO <br /> ADDRESS o 4 &. 5 7 <br /> AGENCY NAME PHOAtB NO <br /> ADDRESS <br /> EM ADDEMS LEAD AGENCY D <br /> o X315 N, i -fd 0 <br /> 0tLip3 5� <br /> 3s. � E C��-g-- <br /> 1)T NURoyno. �3S �0 9 <br /> y <br /> o `75 ENV IR I /SERVICES TH <br /> TIi1S NOTICE 1S SUBJECT TO THE REQUIREMENTS IDEN77I-IFD IN TILE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH D1VISION(EH13)POLICY#92-007.ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EILD FEES AND SERVICE CHARGE MOLUIIONS. STATE WATER CODE, <br /> GOVERNMENT CODE AND THr3 EVIDENCE CODE. <br /> I. A MAXIMUM OF TEN (10)PREMISE ADDRESSES PER REQUEST. <br /> 2. PUBLIC: FILES/RECORDS REVIEW ARE BY APPOINTMGN ONLY. APPOINTMENTS ARE <br /> ARRANGED BY CALLING (204)468-x340. OFFICE HOURS POR APPOINTMENTS ARB 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-REFUNI)A Ill_ DEPOSIT OF 578.40 I <br /> IS REQUIRED. USPOSl7S WILL BB RETURNED TO THE APPLICANT IF THIS PILES/RECORDS ARE <br /> NOT AVAILABLE WITFUN'MR CUSTODY OF THE END. E <br /> 4. THE ABOVE 113IYNTIFIED DEPOSIT IS APPLIED TOWARDS THE "TOTAL FILE REVIEW FEE <br /> CHARGE. THE BALANCE OF THE CHARGES ARE DUE AND PAYABLE rRIO TO REVIEWING THE <br /> DOCUMENT(S)- <br /> S. <br /> OCUMENT(S).S. PUBLIC FIL.ESIRECORDS NOT RETURNED 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 FILEWRECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> SIGNATVRE OF APPLICANT A DATE 1 2- j <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EN 00 14(REV 12/92) <br />