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t:):U'bh'v I <br /> ' C YYIv <br /> yyUS��'A•y��NCJOryAQUIN: COUNTY SERVICES <br /> ENVIRONW-NTAL 11EALTH DMSION y' c 1 4 <br /> PURLIC RECORDS RELEASE APPLICATION <br /> APPUCANT fifer !l r /fes PHONE{ NO � `— <br /> ADnlz.gss <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> KLE Ate- DSS LgAl2 ACiENCY DTE <br /> '40, /' a - --- <br /> c� <br /> fi4rq LC? ldaoA?'- 4--- �3S ;- r� <br /> m v1 ,3S• �L <br /> r 1Z <br /> � �.��.�_��" *r X35.a-co YYLM • <br /> 17ITS NOTICE IS SUIUSC1` To T1IG REQUIREMENTS IDENTIMED IN TIIE PUBLIC HEALTH <br /> SERVIC£SIENVIRONMGNTAL NEAL7'11 DIVISION(Ell 0)POLICY*924007,ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, END FEES. AND 'SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODS AND T14131SVIDENCE CODE. <br /> L. A MAXIMUM OF TEN (10)PREMISS ADDRESSES PER REQUEST. <br /> �I <br /> 2- PIIFII.JC FILES/RECORDS REVIEW ARE RY APPOINTMENT ONLY. APPOINTMENTS ARE i <br /> ARRANGED BY CALLING (209)468-03.0.' OFFICE IiOURS FOR APPOINTMENTS.ARE SCHEDULED <br /> MONDAY THRU FRIDAY HXCLUDING HOLIDAYS, 8:00 A.M. TO L2:00 NOON AND 1:00 P.M. '1.0 4:30 <br /> 3. 'A PUBLIC FIrCORDS RELEASE APt'UCA'nGN AND A NRN.-a - -U fM111_I?DEPOSIT OF$78.00 <br /> IS REQUIRED. DEPOSITS WILL BE RJ61-URNED 1.0 TIIB APPLICANT IF TSL" FILES/RECORDS ARE- <br /> 140T AVAILAOLE WITHIN THE CUSTODY OF THE EIJD, <br /> 4- THE ABOVE IDENTWIEII DEPOSIT IS APPLIED TOWARDS THE TOTAL, FILE REVIEW FES <br /> CHARGE. THE BALANCE OF THE CHARGES ARE DUE AND PAYABLE F_RIOR TO REVRENVING THE <br /> DOC1JMi~NT(S). <br /> S- PUBrJC MLES/RECORDS NOT RETURNED IN THE SARIE CONDITION AS RECEIVED WTL.L BF- <br /> CORRECCED BY THE EHD STAFF AT THE EXPENSE OF THE APPIICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILGED TO T14H APPLICANT FOR PAYMENT. <br /> 6- ORIGINAL PU13UC FILES/RECORDS SHALL NOT BE REMOVED FROM THE END PREMISES. <br /> SIGNAWRE OF APPLICANT DATE 116- "96 <br /> SIGNATURE OF•RELEASING OFFICIAL DATE <br /> F-H 00 14 (REV 12192)' - <br /> ' 3' <br />