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`s <br /> SAN JOAQM COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HFALTIT DIVISION <br /> PUBLIC RECORI)S REUSE APPLICATION oS <br /> APPLICANT �' C ��1 A�V�£v m, �ONF_ No qb 7—/oo b <br /> AGENCY NAME 5 fc PHONII NO P <br /> ADDMS 3a 4 F. %otakg Ay U 4 F/dQ S700,010CA 116Q 2- <br /> FII_B A17DRESS .PAD AG CX DATE <br /> 7 RK <br /> ZNb 43S.aS( SS <br /> -- <br /> 1✓ _fit A� 3 -- <br /> oa 3&9 - 3r -z4 <br /> �t t 2 t Co.,�•... Usa blc�.-- - <br /> 77tIS NOTICE IS SUl1JECT TU THE REQUIREMENTS- IDENTI11RD IN TIIE PUB11C IiF.ALTH <br /> SERVICES/ENVIRONMENTAI-HEAI_TI! DIVISION(FAIR)POLICY 092-007.ORDINANCE CODE OF SAN <br /> JOAQUIN COUN'T'Y, GI1D FT;ES_ AND SERVICE CIIARC49 RESOLUTIONS STATE WATER BODE, <br /> 0OVQRNMBNT CODS AND M18 BVIDE:NCB CODS. <br /> t. A MAXIMUM OF Tel(10)PREMISH ADDRESSES PER REQIJESf. <br /> 2. Pt18i]C I7I_L•S/RECORt)S REVIEW ARE BY dQI'�INTTvirNT Q�l. • APpOIMTMEN'fS AR <br /> ARRANGED BY CALIJNG (299)468-0340. OF1710E HOURS FOR A.PPOINThIENTS ARE SCHfIOLILED <br /> MONDAY THRU FRIDAY IIXCLUDINO IIOIIDAYS, 8:00 A.M.TO 12--00 NOON AND 1:00 P.M. 1.0.4:30 <br /> P.M. <br /> 3. A PI)OLIC RECORDS RELEASE APPtJCA'nON AND A NON-REFUNDAIt[_F Dt:PosITf)'F•i78.00 <br /> IS REQUIRED. DEPOSIT'S WIIL BE RCTURNED TO '1116 APPLICANT IF T11Cs FILGSlRECOit,DS ARE <br /> N0{P AVAILABLE WITHIN'1119 CUSTODY OF THE HIID. <br /> 4. TIIR ABOVE IDENIIMED DEPOSIT IS APPLIED "TOWARDS THE TOTAL FILL: REVIEW/ FEE <br /> CHARGE. '1'IiF- BALANCE OF'ITI�CHARGES ARE UUE ANI.) PAYAHLH -RIO K TO REVIEWING THE <br /> DOCUMENT(S). <br /> 3. PUBLIC FILES/RECORDS K0T 11.0'URNED IN TILE SAME CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHD STAFF AT MiS EXPENSE-OF TIIE APPLICANT. THIS ADDITIONAL <br /> SERVICE WIF.I..BE BII IX0 TO THE APPUCANT FOR PAYMENT. <br /> b. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED MOM TIIE EHD PREMISES. <br /> SIGNATURB OF APPLICANT DATE 01-3U-QE <br /> SIGNATURE OF 1113MEASING OFFICIAL DATE _ <br /> Eli 00 14 (REV 12/92) <br /> n i ,nt. crate W?.V1%4T AFf7n7n rM-ARiArrd Wn>44 RF;Fi L-ne-L <br />