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SAN JOAQUIN COUNI'Y '"W <br /> PLTBI,1(; HEAI,171 SERVICF,S <br /> ENVIRONMEWI'AL IIEAI,TII MVISION <br /> I BLIC RrCORlDS RELEASE APPLICATION <br /> APPIJCANT f2ry(.(.TiNlt,b rn 1/1y ,�i�t.�� iu�sl�� -PHONE NO 2,09- 9Y�'-9-2-oo <br /> ADDRESS P p /3o-X Zo -5A <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> FILE ADDRESS LEAD AGENCY DATE <br /> 13oZ C- - nIrne,.r ;lim . clrw,Ar& ( �cih <br /> 1 Z / S LU. lbQf4 <br /> Yon S A uroPa __ ►3eu e C <br /> 12— 1 7— 0"iii/s gr'15 <br /> y0O r'-e1� <br /> X Sfcr( F . 4r n Ar. 56f E <br /> 417— U ,e-e tU L <br /> 303 ri51 soc �✓3�me,.,7 <br /> L/'(1-I S• Gv1*11e... �,1/a�_ it//14So„ Lr/o rNd�r1�/ <br /> 93/ E • tcl.ed1. & rkA <br /> TI11S NOTICE IS SURJEcT TO Tim REQUIItLMV-N-I-S IDF.N'IIPIED IN 1I1E PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTII DIVISION (F14D) POLICY#924)07,ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, END FFES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> i. A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILES/RECORDS RFVIFW ARE BY APPOINTMENT ONLY. APPOINTMENTS 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 PUBUC RECORDS RELEASE: APPLICATION AND A NON-REFUNDABLE DEPOSIT OF $78.00 <br /> IS REQUIRED. DEPOSITS WILL BF. RETURNED TO TTIE APPLICANT IF THE FILES/RECORDS ARE <br /> NO'T' AVAILABLE WI"ilIIN TIIE CUSTODY OF T -IE E11D. <br /> 4. THF ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEW FEE <br /> ('{IARGF. T11F BALANCE OF TIIE CHARGES ARE DUE AND PAYABLE PRIOR TO REVIEWING THE <br /> DOCUMENT(S). <br /> 5. PUBLIC FIDS/RECORDS NOT RETURNED IN 1I1E SAME CONDITION AS RECEIVED WILL BE <br /> CORREC'T'ED BY THE EHD STAFF AT -ME EXPENSE OF TIIE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED -1.0 ITIS APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE END PREMISES. <br /> SIGNATURE OF APPLICANT( ^��c' r'�1 L"""'4 ?.t—. DATE <br /> SIG <br /> NATURF OF RELEASING OFFICIAL. -- —_—`---------- DATE — <br /> TiI1 00 14 (REV 12/92) <br />