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SAN JOAQUIN COUNTY <br /> CLIC HEALTH SERVICES U <br /> ENVIRONMENTAL HEALTH DIVISION � <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT PHONENO 04 <br /> ADDRESS C)i 7D <br /> AGENCY NAME PHONE, NO i <br /> ADDRESS t: <br /> MAF, Z .1. 1194 <br /> FILE ADDR.P,SS LEAD AGENCY �AVIf?ONHEALTH <br /> I���MITISEISERVICES <br /> twrro <br /> • <br /> YrA <br /> V I). u I <br /> t., tw</Tel Aft <br /> w <br /> Y r1 w <br /> t� s <br /> i <br /> r �� kf • <br /> i <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION(EHD)POLICY#92-007,ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EHD FEES AND SERVICE CHARGE RESOLUTIONS, STATE WAT&R CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE, <br /> 1. A MAXIMUM OF TEN (10) PREMISE ADDRESSES PER REQUEST. J <br /> Z. PUBLIC FILES/RCORDS REVIEW ARE BY APPOIMgN'',• NQ_LY. APPORTIN0811M ARE <br /> .ARRANGED BY CALLING (209)458-0340, OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br /> MONDAY THRU FRIDAY EXCLUDING HOLIDAYS, 8:00 A.M. TO 12:00 NOON AND 1:00 F.M. TO 4:30 <br /> P.M. <br /> , <br /> 3. , ... A PUBLIC RECORDS RELEASE APPLICATION AND A NON-REFU. b DE' 'OSIT OF$78.00 <br /> IS REQUIRED. DEPOSITS WILL BE RETURNED TO THE APPLICANT IF THE FILES/RECORDS ARE <br /> NOT AVAILABLE WnWN THE CUSTODY OF THE EHD. <br /> 4. THE A13OVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS-THE TOTAL FILE REVIEW FEE <br /> CIEIARGE. THE BALANCE OF THE CHARGES ARE DUEAND PAYABLE PRIOR TO REVIEWING THE <br /> DOCUMENT(S). <br /> 5. PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RESCUED WILL BE <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL.BE BILLED TO TIM APPLICANT FOR PAYMENT. j <br /> G. ORIGINAL PUBLIC FILES/RECORDS SMALL NOT BE REMOVED FROM THE :Hi PREMISES. <br /> SIGNATURE OF APPLICANT 4,Z DATE $ <br /> v <br /> SIGNATCJRfi OF RELEASING OFFICIAL DATE <br /> �Vt EH 00 14(REV 12192) <br /> I <br /> ZO'd 0096t9ZT Ol W08=1 WOT:80 b66T-ST-£0 <br /> I . <br />