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t X)VANCED GEOENV I RCNM :Q9 •cls 1[ 4-f � <br /> SAN JOAQUIN COUNTY <br /> f PUBLIC HEALTH SERVICES <br /> ENVMONAIMWAL HEALTH DIVISION <br /> PUBLIC RECORDS RELE"E APPLICATION <br /> A.PPLICAmr Oidl (4- o - PHONE NO *? d� <br /> ADDRESS IIp <br /> AGENCY NAME PHONE NO4=4aRF <br /> ADDRESS <br /> • B ADUERSS LEAD A!29NCY 12A�$ <br /> W r <br /> -mfIS NOTICF- IS sLJLiIirCF TO 11113 Rr:QUIRr-Mr..NYS ID[eI4T1171ED, IN 1-1111- PUBLIC HEALTH E <br /> SL-RVICr-SIZNVIRO.whiGNT-4,1,14 AI_T}i L71vI5I(3N (Fill)) PojjCY#92-007,ORDINANCE COOS OF SAN � <br /> JOAQUIN COUNTY, [IID TEES A?4D SERVICE CI{ARGE RESOLU11ONS, STATE WATER CODE, � <br /> QpV,ERNMENT CODS AND THE BVIDENCS`CODR. <br /> I, A MA.XIMUbf OFTEN (10) PREMISE:ADDRESSES PER REQUEST. <br /> 2. 1`11111-1C I-II.R'SIRECORDS REVIEW ARF BY A1:I?UII+IT!�1I:)�L Of11.1. 11P1'�7IN1'RlCi�f3'S ARE F <br /> ARRANGI-4) 13Y CALLING (209)46:3-031413. OFFICE HOURS FOR APPOIN7•hiENTS ARE SCIIEVULED <br /> MONDAY THRU I=RI13AY E XCI-L)DING HOUDAYS. 8-.(X) A.hi, 'TO 11:00 N0014 AND 1.W I' ht.'T4 4:30 <br /> 3. A PUBLIC 1115CORDS RELEASE API'LICA-110N A1140A �Inh1.12L'F=UfYi2 1n 11Tr bi-irOSPC or S78m <br /> IS REQUIRED. DI;I'OSI•TS WILL $E Fu-n-URNED•TO 771[ APPLICANT H' 774L• FIL -VRECORDS ARC <br /> - <br /> NOT AVAILA-BLE WITHIN T14E CUSTODY OF THP E)tD. <br /> 4. THE ASOVI; IDENTIFIEn DE=POSIT IS APPdaCU TOWARDS THC- TOTAL FILE RF-vTEw Flit <br /> CHARGE. '3'7-IE BALANCE OF 111E CIIARGES ARE DUE?AINE) PAYABLE ERIUK TO RE-VIE1VING TH13 <br /> DOCU)AENT(S). F` <br /> S. PUBLIC FIL raSlRCCORDS NOT YZETURNE-0 IN TIME SAME CONDIT10,4 AS R E;CUIVED WILL BE <br /> C(7RREGTETI BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS AUDFTIONAL <br /> SERVICE WILL BE BILLL-0 TO THE APPLICANT FOR PAYMENT'_ i <br /> 6. ORIGINAL PUBLIC I~IIF.SIRECORDS SHALL NOT BE R1;A30VE9 I=RU&t THS ERD PREMISES. <br /> h <br /> - � I <br /> SIGNATURE OF AFPUCANT DATE <br /> SJONATURE OF RELEASING OFFICIAL DATS <br /> EH 00 14 (RSV 13192) <br /> r. <br /> y <br />