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s� <br /> `rt <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMTNTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT_ --III►d G/)LL 6 Ht:g /�7f✓<n►l ST l iVOPOCPAJ PHONE NO r91,�) - )o <br /> ADDRESS_ 1010 79A0 e.6 -r A S)k'k9 rkM CA <? l <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> FILB ADDRESS LEAD AGENCY DATE <br /> XC6 khf ,I)D ! IOVI' A(lwpko-l)o J <br /> 23 6 IJ6rzru �AN1 LANs (C1IyRoy ) <br /> :�a`� sort l )t ' 70l> .. _,-�•• <br /> 3 Swi a <br /> PAULL - 1p %z/900 <br /> J,JI sT 1_nl)( Nvr ''u�`, <br /> ON <br /> rrIV�HO��M <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION(EIID)POLICY#92-007, ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EHD FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1. A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILES/RECORDS REVIEW 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 PUBLIC RECORDS RELEASE APPLICATION AND A NON-REFUNDABLE DEPOSIT OF $78.00 <br /> IS REQUIRED. DEPOSITS WILL BE RETURNED TO THE APPLICANT IF THE FILES/RECORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE 1311D. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEW FEE <br /> CHARGE. THE BALANCE OF THE CHARGES ARE DUE AND PAYABLE PRIOR TO REVIEWING TIIE <br /> DOCUMENT(S). <br /> 5. PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORREC`MD BY THE MID STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDI'T'IONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. f <br /> 6. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> SIGNATURE OF APPLICANT L DATE4 1 Z <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 12/92) <br /> p <br />