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_mow I C,y_ <br /> 3 `-1 <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> VNVIRONMII+NTAL IIEALTH DIVISION <br /> P'LT#II.IC RECORDS RELEASE APPLICATION <br /> ` 4; <br /> i <br /> APPLICANT l�Q ` PH4NI3 IrtO <br /> ADDRESS <br /> AGFNC'Y NAMEtJG PHONE NU�='rn' T / � <br /> ADDRESS-a u v cT <br /> VILE rwL'ILFSs I-Iwi.n_l) AQ9NCY DAIE <br /> a' .l � -t - rn rn 35: J-7 -/1-5. <br /> 17 <br /> l tIlc is- -� <br /> i <br /> THIS t-10110E IS SUBJECT TO TIIE REQUIREMENTS IDEN7lFl1;1) IN THE PLIBLIC NEALTH <br /> SSIiVICJ?S/ENVIRONMENTAL 14GALTll DIVISION(F110)POLICY#92-007,ORIANANCS CODE OF SAN <br /> 3OAQU`IN COUNTY, FBI) FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE. <br /> GOVERNmEmr CODE AND THE EVIDENCE CODE. <br /> 1. A MAXIMUM OF TEN(10)PREMISK ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILES/RECORDS REVIEW ARE BY API'OINI'MI3NT ONLY- At K)INTMENTS ARE <br /> ARRANGER BY CALLJNG (200)468-0340. OFFICE !TOURS FOR APPOINTh1ENTS ARE SCHEDULED <br /> MONDAY 1HRU FRIDAY EXCL.UI31N17 HOLIDAYS, 8.00 A.M. TO 12:00 NOON AND 1:00 P.M. TO 4:30 <br /> P.M. <br /> i <br /> 3. A PUBLIC RECORDS RELEASE APPLJCA'11(:)N AND A NON-RFFLINI)A111_F DI?POSIT OF 578.(10 <br /> IS REQUIRFD. DEPOSITS WILL SH RETURNED TO TILE APPLJCANT IF'i14E FILES/RECORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE E"D. <br /> 4. THE ABOVE IDEN11FIIA) DEPOSIT IS APPLIED TOWARDS "DIE TOTAL FILE REVIEW FEE <br /> i CHARGE. THE BALANCE OF THE CHARGES ARE DUP AND PAYABLE PRIOR TO REVIEWING THE <br /> DOC''UMENT(S). <br /> t 5. PUBLIC h"IL.ES/C«CORI)5 N(Yr RE-MRNIRD IN THE SAME CONDITION AS RECEIVED WILL BE <br /> i CORRI?CTED BY THE E.HD STAR' AT THF_ EXPENSE OF THE APPLJCANI". I1-US ADDI ONRL. <br /> SFRVICE W11.1,BE HILLFU TO THE APPUCANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED i'KOM"lUE GIiL)PREMJSES. <br /> SIONATURE OF APPI2CANT )5A1E <br /> SIGNATURE OF RELEASING OFFICIAL _ DATS <br /> FH Od 14 (REV 12192) <br />