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r SAN JOAQUIN COUNTY <br /> ' '`PUBLIC HEALTH SERVICES <br /> ENMONMENTAL HEALTH DIVISION <br /> - <br /> pljBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT PHONE NO - 0/ <br /> FZ <br /> ADDRESS 2 - r e rc l� S <br /> AGENCY NAN1E Z r 2 PHONE NO <br /> ADDRESS LEM -� <br /> ADDRESSLE�?► GB � PIMM <br /> 5-97 S 3 Lu L RD S� <br /> o h KD _STN <br /> 1• ,r <br /> 91, <br /> S`T 12 -- , <br /> 9 9c.T r _i ill) rt <br /> _ y <br /> AL <br /> i <br /> Fn <br /> f <br /> THIS NOTICE IS SUR ECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICESfENVIRONME qTAL HEALTH DMSION(FHD)POLICY#92-007, ORDINANCE CODE OF SAN <br /> JGAQUIN COUN'T'Y, El n FEES AND SFRVICV- CHARQR RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE THE EVIDENC 13 COVE. <br /> C.0 <br /> 1. PUBLIC FILES CORDS REVIEW ARE BY Ap iN'ITMENT ONLY. APPOWTMENTSe-_ARE -': .; <br /> ARRANGED BY C a (209)468-0340. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDLTtED <br /> MONDAY TRRRU FRIDA Y EXCLUDING HOLIDAYS, 5:00 A.M. TO 12:00 NOON AND 1:00 <br /> 2. A PUBLIC RECORDS RELEASE APPLICATION AND A NON-REFUNDABU DEPOSIT OF 518.00=; <br /> IS REQUMED. DEPO S WILT. BE RETURNED TO THE APPLICANT IF THE FiLF.S/RECORD��RE_;-r� <br /> NOT AVAILABLE THE CUSTODY OF THE FID. <br /> 3. THE ABOVE ED DEPOSIT IS APPLIED 'TOWARDS THE TOTAL FII.E REviE r <br /> CHARGE. THE 8 CE OF THE CHARGES ARE DUE AND PAYABLE PR[Og TO REVIEWING THE ~— <br /> DOCUMENT(S). <br /> 4. PUBLIC FILES LECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE IIID STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE TO THE APPLICANT FOR PAYMENT. <br /> S. ORIGINAL PtJB C FUM/RECORDS SHALL NOT BE REMOVED FROM THE EHD PRPASES. <br /> SIGNATURE OF APPLI ANT �;F���� <br /> DATE 6 �O <br /> SIGNATURE OF RELEASING OFFICI DATE <br /> EH 00 14 (REV 10/42) <br /> 1 ' d LE : 11 25i0Ei0i W08-4 <br />