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1-27-199% 4: 1 FJVM F-F!L' flit <br /> SAN JOAQ N COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRON DENTAL 14IEALTH DIVISION <br /> PUBLIC RECORDS ILELEASE APPLICATION <br /> APPUCANT- IAS- ,, -t7�.��� pxorra N0C�2 _ sf��46� <br /> ADDRPSS I M5 W-Alam--t A <br /> AGENCY NAME, ,��3- PHONE NO <br /> ADDRESS <br /> EL13 ADDRP-SS Lam`-a Ate" ODA <br /> RrL�/� s • .1� 24 a 7i Al 35-..1--7 <br /> CD�L�c3-i4 �.�-. � ��'' ak✓� 3 -x-0 <br /> IIIIS NO'nCE IS SUI3JECC TO TI11; REQUIREMENTS IDENTIFIED IN I-IIE PUBLIC HEALTH <br /> SERVICES/ENVIRONh.SEN7'AI_HEAI-Ttl DIVISION (FIID)POLICY#92-007,ORDINANCI:CODE OF SAN <br /> JOAQUIN COUNTY, EIID FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE. <br /> GOVERNMENT CODE AND THE BVIDENCB CODE. <br /> I. A biAX11r1Ut.f OF TEN (10) PREMISE ADDRESSES PER REQUEST. <br /> 2. PI1glJC FILES/RECORDS REVIEW ARE AY AUOI?NTMENT ONLY. APPOINTMEN"I-S ARE. <br /> ARRANGED BY CALLING (204)368-0340. OFFICE HOURS FOR APPOIN,11%LENTS ARE SCHEDULED <br /> ?MONDAY TtIRU MDAY ILXCLUDIN(7 HOLIDAYS, 8:00 A-M- TO 12:00 NOON AND 1:00 P.M.TO 4.30 <br /> 3, A PUBUC RC-CORDS RE-LEAS13 APPLICATION AND A NUN-REFUNI)L►1i1 1=DCPOSYT OF 578.00 <br /> IS REQUIRED. DEPOSITS WILL BE REYURNED 7'0 THE APPLICANT IF TIM,PILES/Rl:-CORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OP THIS MiD. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THl 'TOTAL FILE REVII_W FEE <br /> CHARGE. THE BALANCE OF THE CHARGES ARE DUE AND PAYAH E MOR TO REVIEWING THE <br /> DOCUMENT(S). <br /> S_ PUBLIC FILES/RECORDS NOT RETURNED IN Tl1E SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE END STAFF AT I'HF- EXPENSE OF THE APPLICANT. THIS ADOMONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILESIRECORI3S SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> SIGNATURE OF APPLICANT DATE - <br /> SIGNATURE OF RELEASING or FICIAL. DATE <br /> EH 00 14 (REV 12192) <br />