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S-13-1996 4:58PM FROM IVU 2t7& -"!Dti a 1 tit �` / <br /> /-j-/e <br /> G'J SAYN'rJOaA�Q�UIN C�+OL�LWTY�.�+ <br /> . \w• PUBLIC HEALTU SERVICES <br /> ICES - <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> '3 r <br /> APFLICANT ►p v'i M c-K • MONE NO <br /> ADDRESS <br /> AGENCY PHONE NO <br /> ADDRESS <br /> FII BSP �z� DA1 B <br /> 5.6 IV- groodw-t Avv.. nil- r H <br /> 176 o W. Brava gam:'_ 9 c. <br /> 3137, 944 we litr G <br /> i 6 �i ► Shaw ---------- <br /> Rd. 3S a rti"rt. <br /> 150c Shaw 3 " •Z� <br /> q 31 o --- <br /> Zx�'i C h4ro +e t 351 <br /> 3635' ChtaoDC-t — -- -- <br /> 'IRIS NO-NCB IS SUBJECT To THE REQUIREMENTS IDENTIFIED IN T"E PUBLIC' HEALTH <br /> SER VICFSMNVIRUNIviENTALHEALTH DIVISION(EID)POLICY x-007,ORDINANCE CODE OF SAN <br /> JO1#QLFIN CaUNTY;EIiD"FEIxS•AND SERVICE CHARGI;�"RES(JLtMONS;"'STATE-WA3�R=CODE; <br /> GOVEMMENT CODE AND THE EVIDENCE.CODE-' <br /> I. A MA3dMUAI OF TEN(10)PI RJ HSII ADDRESSES PER REQUEST.., <br /> 2. PUBLIC FILESIRECORDS pFVIEW ARE BY APPOItI3MENT ONLY. APPOINTMENTS ARE <br /> ARRANGED $Y CALLING (209)418-0340. OFFICE Y-1OURS FOR APPOINTMENTS ARE SCHEDULE <br /> MONDAY THRU FRIDAY EXCLUDING HOLIDAYS, 9.00 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-REPUNDABL,DEPOSIT OF 578.00 <br /> IS REQu1RED. DEPOSITS WILL, BE RETURNED TO THE APPLICANT IF THE FILESIRECORDS ARE <br /> NOT AVntr1►rartF' rnlI I THE CI75'17DDY OF THE EUD. ,. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEW FEE <br /> CHARGE. TIjE BALANCE OF TEIE CHAROBS ARE DUE AND PAYABLE PRIOR TO REVIEWING THE <br /> DOCUMENT(S). f <br /> S. PUBLIC FIL.PS/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRLCTED BY THE END STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDrnONAL <br /> SERVICE wiLL 13E BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBIC FILESMECORDS SMALL NOT BB REMOVED FROM THE END PREl1i1SFS_ <br /> SIGNATId E OF APPLICANT 4fu DATE. ! Mat' <br /> SIGNATURE OF RELEASING OFRaAL DATE <br /> EH 00 14 (REV 12192) <br />