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SAN JOAQUIN COUN'T'Y 7c/ <br /> PUBLIC HEAL'T'H SERVICES <br /> ENVIRONMFN'TAL HEALTH DIVISION <br /> ,nMLIC RECpRDS RELEASE APPLICATION <br /> Su2anne t�exT<c��san <br /> APPLICANT PHONE NO L110'74JO <br /> ADDRESS 14005 eA- e. <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> FIL$ AADRm ]LEAD AGENCY DA ; <br /> 1 <br /> amme <br /> 3sig E. HA <br /> W, 5-whooL <br /> US <br /> THIS NOTICE IS SUBJECT TO 'INE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICESJENVIRONMENTAL HEALTH DIVISION (EHD)POLICY 992-007, ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EIID FEES AND SERVICE CHARGE MOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1. A MAXIMLIM OF TEN (I0) FR.EMISE ADDRESSES PER REQUEST. <br /> 2. PUBLIC nLES/RECORDS REVIEW ARE BY APPOINTMENT ONLY. APPOINTMQJTS ARE <br /> ARRANGED BY CALLING (209)46E-0340. OFFICE FiOURS FOR APPOINTMENTS ARE SCHEDULED <br /> MONDAY T14RU FRIDAY EXCLUDING HOLIDAYS, £;:00 A.M.TO 12:00 NOON AND 1:00 P.M. TO 4:30 j <br /> P.M. <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION AND A NON-REFUNDABLE DEPOSIT OF$78.00 <br /> IS REQUIRED. DEPOSITS WILL BE RL-TURNED TO TILE APPLICANT IF THE FILESIRECORDS 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 FILESIRECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THIS EHD STAFF AT T14B EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILESIRECORDS SHALT..NOT BE REMOVED FROM THE EHD PR.ENUSES. <br /> SIGNATURE OF APPLICANTZa� Dr,; :' 2"3, <br /> SIGNATURE OF RELEASING OFFIC31 DATE <br /> IH 00 I4 (REV 12/92) <br />