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K� 2()3� 7�c� c, '4 <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH bIVISION ' <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCANT � 4_�__ PHONE NO_ N' <br /> ADDRESS <br /> AGENCY <br /> tt NAME _W'- PHONE NO <br /> ADDla��a7S 6- 't- <br /> r <br /> t <br /> k �� LEAll AGENCY <br /> NT <br /> r { _ to. 0A <br /> 010 j: <br /> - <br /> _ 994 <br /> 3 <br /> VI is�NVIRONMENTA � �t�A1v!#t1j� <br /> - <br /> THiS NOTICE 'I <br /> IS SUBJECT TO TII3 REQUIREMENTS IDENTIFIED IN THE PUBLIC HEAL- -- TH <br /> SERVICLVENVIRONMENTAL HEALTH DIVISION(EHD)POLICY#92-007,ORDINANCE CODE OF SAN µ <br /> JOAQUIN COUNTY, EHD FEES AND SERVICE CHARGE RESOLUnONS, STA'T'E NATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. , <br /> 1. A MAXIMUM OFTEN (10) PREMISE ADDRESSES-PER REQUEST. 44 , 'r <br /> 2. PUBLIC FUM/RECORDS REVIEW ARE BY AI'POINTMBNT ONL7� S. -APPOIN11CM ARE ` <br /> ARRANGED BY CA.LIING (209)468-0340. OFFICE HOURS FOR - ARE SCHEDULED <br /> MONDAY THRU FRIDAY EXCLUDING HOLIDAYS, 8:00 A.M. TO 12:00 NOON-AND 1:00 P.M.TO 41311. <br /> P.M. <br /> 3. A A PUBLIC RECbRDS RELEASE APPLICATION AND A NOI•j ,IDEPOSIT OF$78.00 . <br /> IS REQUIRED. DEPOSITS WILL BE REnMNED TO THE APPUCANT IF THE FUESMECORDS ARE '. <br /> NOT AVAILABLE wrra N THE CUSTODY OF THE EHD. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL. FTLB REVIEW PEE <br /> CHARGE:,THE BALANCE OF THE CHARGES ARE DUE AND PAYABLE MM TO REVIEWING THE <br /> DOCUMENT(S). <br /> S. PUBLIC FIX-WBCORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE•EHD`STAFF AT THE EXPENS13 OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILL$D TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. . # <br /> SIGNATURE OF APPLICANT ' <br /> DATE <br /> SIGNATURE OF RELEASING OFFICIAL. DATE <br /> Ell 00 14 (REV 12/92) <br />