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SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT (ego^�1CfJ PHONE NO 9 S(o -O,�tv4 <br /> ADDRESS k?'0 3 1d. My-r—k L-c vte F S"LA-c A , §Fo c-c_{ , C'A �v% <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> FITS ADDRESS LEAD AGENCY DATE <br /> I(�� usfrcis PA'lcyrlyc, Ploo�cc c+ ?4-51 eq D <br /> 1103 S II'laih S-tree-E, 1'hc�n+c�— S -Et}p <br /> llb3 S. VYlciii S'Fcert, Plaoicc,; PH-S FJ4>7 <br /> tvlic s. mail, Sleect, MAv,tccu PNS Im? <br /> goo Jy4yAr►ctl pGrlc Drive, wy-,,, rce e4s -fl P <br /> lIs3 1kmdf-A ilf 6n' lc, m ahtecti WS l6ffD <br /> q�p�YM�N <br /> 19Q4 <br /> CO TY <br /> SAN J SER <br /> HEALT \j1C <br /> ��vv UC H <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDEN-AN 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 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 EHD. <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 THE <br /> DOCUMENT(S). <br /> 5. PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> SIGNATURE OF APPLICANT ` �41 t�etcr� DATE 3- r�- q <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 12/92) <br />