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1-2 7-199 7 4.: 1 OPM E -I- wUtl ivV GYJ� moo Tui rxi • <br />SAN JOAQUIN COUNTY <br />PUBLIC HEALTH SERVICES <br />FNVIRONNIO&WAL HEALTH DIVISION <br />FU.LILIC RECORDS RELEASE APPLICATION <br />APPLiCAI�'T G C �r� 7 067" ' PHONE NOC-Au°t) rZ-6 <br />ADDRESS IFA5 rr �y9` <br />AGENCY NAME— -PHONH NO <br />ADDRESS <br />3-74 &,iry z <br />3 <br />-Ge , <br />w <br />ALIS Noncr-- IS stjwccr TO T1IE REQUIREMENTS IDCNTIFIED W THE PUBLICF4EALTiT <br />SCRVICGSIENVIRONNIENTALHEAI.TFI DIVISION (1:110) POLICY A92-007, ORDINANCE CODE OF SAN <br />JOAQUIN COUNTY, SLID FEES AND SERVICE CHARGE RESOLUTIONS, S'I'A'CE WATER CODE. <br />GOVERNMENT CODS AND THE HVIDENCH CODE. <br />I. A hfAXIhLU&j OF TEN (10) PRI -7 -MISS ADDRESSES PER REQUEST. <br />2. M1131IC. FII_ESIRECORDS RI:VIFtiV ARE AY AF Ol ThiGNT ONt.Y. APi'OiNTb1ENl'S ARE <br />ARRANGED BY CALLING (209)368-0340. OFFICE HOURS FOR APPOWI'h1EN"TS ARE SCHEDULED <br />NIONDAY TIIRU FPJDAY 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 APPLICA'nON AND A NON-REFU14-1) [.E: DEPOSIT OF 579.00 <br />IS REQUIRED. VEPOSI'CS wll.L. BE RE"1'URNED TO 7IiE APPLICANT IF TFil3, FILLS/RIiCORi)S ARE- <br />NOT <br />RENOT AVAILABLE WITHIN THE CUSTODY OF THE 6110- <br />4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THL TOTAL FILE_ REVIEW FEE <br />CHARGE. THE BALANCE OF TALE CHARGES ARE DUE AND PAYABLEII' O TO REVIEWING THE <br />DOCUMENT(S). <br />S. PUBLIC FILES/RECORDS NOT RETURNED IN TLIE SA&IS CONDITION AS RECEIVED WILL BE <br />CORRECTE!n BY THE EHD STAFF AT THE EXPENSH OF THE APPLICANT. THIS ADDITIONAL <br />SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br />6. ORIGINAL PUBLIC pLLES1R.ECODS SHALL. NOT BE REMOVED FROM TMI <br />HE EHD PRESES. <br />R. <br />SIGNATURE OF APPLICANT <br />SIGNATURE OF RELEASING orFICLAL <br />EH 00 14 (REV 12/92) <br />DATE I -,*I. Y -- <br />DATE <br />