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SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ELN VIRONME,NTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT PHONE NO <br /> ADDRESSq5ld <br /> AGENCY NAME PRONE NO <br /> ADDRESS <br /> FILE ADDRESS LEAD AGENCY DATE <br /> .1--1. <br /> to r <br /> '7u <br /> u <br /> rn <br /> '1 n Ir <br /> Ito L <br /> U �► <br /> 11 <br /> Ir r <br /> O q h <br /> TRIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PU13.U.0 HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION(EFID)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 QNLY. 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—REFUNDABI.Ir 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 — DATE 3 � Y <br /> SIGNATURE OF RELEASING OFFICIALy DATE <br /> EH 00 14 (REV 12/92) <br /> C0'd 0086b9r T Ol WOJJ l4jO T :80 t766 T-S T-SO <br />