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SAN JOAQUIN COUNTY <br />PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT aGc. k ,.Taws L( PHONE NOL9l� <br />ADDRESS '3d,3:5 Suri 5 c 131 v Su( -k 5- 4Pi4" C4 c1575/2 <br />AGENCY NAME_ X - A 4 PHONE NO 5w,► a � cz boy.-� <br />ADDRESS 5ew� <br />Q L 5 c s r c I Y -o jo >9 <br />FILE ADDRESS LEAD AGENCY DATE <br />THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br />SERVICES/ENVIRONMENTAL HEALTH DIVISION (EHD) 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 ONLY. APPOINTMENTS ARE <br />ARRANGED BY CALLING (209)468-0340. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br />MONDAY T 4RU 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-REFUNDABLE DNEIVED <br />PC <br />IS REQUIRED. DEPOSITS WILL BE RETURNED TO THE APPLICANT IF THE FIL1 <br />NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. ��ffff <br />.1111 1 2 1 9 <br />4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTA441 <br />CHARGE. THE BALANCE OF THE CHARGES ARE DUE AND PAYABLE PRIORIPIDIS <br />DOCUMENT(S). <br />ENVIRONMENTAL HEALTH DIVISION <br />S. 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 J� ,Q rI DATE -7 <br />SIGNATURE OF RELEASING OFFICIAL DATE <br />�� EH 00 14 (REV 12/92) <br />1 <br />J- <br />1- L� z <br />-- <br />Sov +1 fit,✓(:h <br />5) <br />3 � 5' - <br />� -F- L.ar✓ � s c Acro . <br />�) <br />2)pMinh <br />L" nl l <br />��� <br />_ �LLYi <br />THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br />SERVICES/ENVIRONMENTAL HEALTH DIVISION (EHD) 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 ONLY. APPOINTMENTS ARE <br />ARRANGED BY CALLING (209)468-0340. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br />MONDAY T 4RU 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-REFUNDABLE DNEIVED <br />PC <br />IS REQUIRED. DEPOSITS WILL BE RETURNED TO THE APPLICANT IF THE FIL1 <br />NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. ��ffff <br />.1111 1 2 1 9 <br />4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTA441 <br />CHARGE. THE BALANCE OF THE CHARGES ARE DUE AND PAYABLE PRIORIPIDIS <br />DOCUMENT(S). <br />ENVIRONMENTAL HEALTH DIVISION <br />S. 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 J� ,Q rI DATE -7 <br />SIGNATURE OF RELEASING OFFICIAL DATE <br />�� EH 00 14 (REV 12/92) <br />1 <br />