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I��eJti�I��b b lJ FrM r-I-CUFI AUM moo 'ej i eau C/r✓ Fes/ <br /> SAN JOA4UIN COUNTY <br /> PUBLIC HEALTH SERVICES L, Yl/ <br /> F�RaNMF.NTAL 1IF�,TH DIVISION / 1 <br /> YUIdLXC jMCORDS RF.LFASE APPLICATION <br /> PHONE NO zn <br /> APPlJCANT 7 <br /> ADDRESS 2PHONE X10 <br /> AGENCY 1�[AME <br /> ADDRESSBLE <br /> AMR= P.AD DA"� <br /> o r 4- 3 s a c, SS e7- -t4 <br /> o 35- <br /> a roc vt) 3S.. <br /> N <br /> 4 SB22x -h _ S. ICJ ` <br /> TIHS NOTICE IS SUII.IECT TO 'nlE REQUIREMENTS IDENTIF=IED IN TI(E PUBLIC HEALTH <br /> SERVICESIENVIRONMENTAL HEALTH DIVISION(EIID) POLICY#924)07. ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EHD FEEDS AND SERVICE CHARGE RESOLUTIONS. STATE WATER CGDE, <br /> GOVERNMENT CODB.AND THE-EVIDENCE CODE. <br /> I. A MAXIMIUM OF TEN (10) p1 EMjsI3 AI]DRFSSES PER REQUGST. <br /> 7. plit3Il[` FII-I-S/RrCORDS RRVIF.W ARE IIY APPOIN-MIENT ONLY. APPOINTMENTS ARE <br /> ARRANGED BY CAL(.1NG (209)46a-0340. OFFICE HOURS FOR APPOIN111ENTS ARE SCHEUULF-D <br /> MONDAY THRU FRIDAY EXCLUDING VOLlDAYS, 8:00 A.M. TO 12:00 NOON AND 1:00 P.M.TD 4:30 <br /> P.M. <br /> 3. A PUBUC RECORDS RELEASE API*LIGATION ANDA NUN-REFUN116WAF.DEPOSIT OF x78.00 <br /> IS REQUIRED. DEPOSITS WILL BE RETURNED TO THE API L]C:ANT IF THE FILESIRECOELDS 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 BALANCfi OP'Mfi CHARGES ARE DUE AND PAYABLE tR10—R TO REVIEWING THE <br /> DOCUMENTS). <br /> 5- PUBLIC FILES/RECORDS NOT RETURNED IN 131E SAME.CONDITION AS RECEIVED WILL BE <br /> CORPLECTEY) BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT, THIS ADDITIONAL. <br /> SERVICE WILL. BE BILLED TO THE APPLICANT FOR PAYMENT- <br /> ORIGINAL PUBLIC PIM' /RECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> SIGNATURE OF APP11CANT —.DATE <br /> SIO NATLME OF RELEASING OFFICIAL. DATE <br /> 0100 14 (REV 12192) <br />