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SAN JOAQUIN COUNTY <br /> PUBLIC HEAL'T'H SERVICES � <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 140-1'J E� ►r.-a,�,� G�c i PHONE NO �! b <br /> ADDRESS r01-0 zve/ucii4 La s /dor t u- - c-A <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> kM33 ADDRESS LEAD AGENCY DATE <br /> r�,�ti er 17 <br /> I - A <br /> 79/u aefvm <br /> S�e�I 3 - / Stk 4�r <br /> Par4ki Sf <br /> QreuAe.r3--+'7 11, u -t <br /> � Z1 Ac.,,(-A. 4 <br /> Oron.lo"i it s <br /> ZZ36 A fk k <br /> C'v. k & chevn , 316.6.9,, <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HI3ALTH DIVISION(EHD)POLICY X992-007,ORDINANCE CODE OF SAN <br /> JOAQQUIN COUNTY, EHD FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> I. PUBLIC FILES/RECORDS REVIEW ARE BY AP_I'OINTMENT ON . 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 /> 2. A PUBLIC RECORDS RELEASE APPLICATION AND A N_O -REFUNDABLIs 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 /> 3: 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 /> 4. PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHD STAFF AT THE EXPBNSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BMLED TO THE APPLICANT FOR PAYMENT. <br /> S. ORIGINAL PUBLIC FILESI"CORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> SIGNATURE OF APPLICANT d'L DATE /f_ .r"7 IF Z <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 10/92) <br />