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i fd'-V_1t4 !�Jb b:ICJCIYTI T rlJrvi�HI+G •e�: �r.� .�:�u r�i rx �! / ��" , -— <br /> V <br /> SAN JOAQUIN COUNTY �.c:C� /4lc/-cA-V- <br /> LIC HEALTH SERVICES r <br /> ENVIRONNW-NTAL HEALTH DMISION <br /> // P'URUC RECORDS RELEASE APPLICATION <br /> APPLICANT PRONE NO g-s-L -&!Zy <br /> ADDPWSS / O-� <br /> AGENCY NAME ZEI5 PHONE NO —� <br /> ADDRESS <br /> FILA ADDRESS LEAD AGENCY <br /> m d 3s z� SS <br /> ADI -- - <br /> aiW7 <br /> cn 649 ZU <br /> m rr 3S. m L <br /> m ITIS ._. ��^-���w <br /> 1�� ls(? }r <br /> TITIS NOTICE IS SUtuECT TO Tlfar RC-QUIREMENTS (DENTWJED IN THE PUBLIC 11EALTH <br /> SERVICES/ENVIRONM1-NTAL)4EAL7I1 DIVISION(FID)POLICY#92-007, ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, FJI:D FEES. AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THIS ]EVIDENCE CODE. <br /> I.- A MAXIMUM OP TEN (ID) PREMISE ADDRESSES PER REQUEST. <br /> 2- PLIBL,JC F11LF-49/11ECORDS REVIEW ARE RY APPOINTMENT ONLY. APPOINTMENTS ARE <br /> ARRANGED BY CAWNO (209)466-0344U.' OFFICE IIOURS FOR APPOIN-MIENTS ARE SCHEDIJI-ED <br /> MONDAY THRU FRIDAY HXCLUDING HOLIDAYS, 8;00 A.M. TO 13:00 NOON AND LIDO P.M.TO 4:34 <br /> P.M. <br /> 3. A PULIUC RE-CORDS RELEASE Arl'UCA,nON AND A tj0tj-R j;F-UN !3 ;DrspOSI"E'OF$78.00 <br /> 1S REQUIRED. DEPOSITS WILL.. BE RL-1`URNED 1.0 THE APPLICANT IF TILL'• nLErSJRECORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF'IWE WID. <br /> 4_ THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL_ FILE RSVISW FEE <br /> CHARGE. THE BALANCE OF THE CHARGES ARE DUE AND PAYABLE PR10 TO Ria-VIENVING THE <br /> DOCUMENT(S). <br /> 5. PUBLIC I ILES/RE;CORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE , <br /> CORRECTED BY TH13 EHD STAFP AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SER ICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBUC PILL?.SIRECORDS SHALL NOT BE REMOVED FROM THE EMD PREMISES. <br /> SIGNATURE OF APPLICANT , DATE <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 12192) <br />