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r � <br /> SAN JOAQUIN COUNTY K <br /> 1YU13LIC HEALTU SERVICES <br /> F t0NI1lENTAL ITEA LTH DISION <br /> PUBLIC RECORDS RELEA3E APPLICATION <br /> A.PPLICAN'I' _ '' <br /> 1 � PHONE NO SJrr� <br /> ADDRESS f r i'' �' �: <br /> AGENCY NAME PHONE ND _r'1l1f/21k`_ <br /> �II.S <br /> ADDRESS LEAD Ai3EMXDATE <br /> (` LL.1LLi-v -- t. , <br /> ,300 r— <br /> { <br /> TATS NOTICE IS SUBJECT TO THE REQUIRE IDENTTFIBD IN PUBIC HEALTH - <br /> SERVICES ENVIRONMENTALNEALTH DIVISION(ERD) -ICY -007,ORDINANCB'CODB OF SAN <br /> JOAQUIN COUNTY, EHD PEPS AND SERVICE CHAR B RESOLtMONS,'STATB' WATER CODE, <br /> GOVERNMENT CODS AND THE EVIDENCE CODE. <br /> t. A MAXIMUM OF TEN (la) PREMISE ADDRESSES PER REQUEST. _ <br /> 2, PUBLIC FaSS/RPSCORDS REVIEW ARE BY O APPOWTMI3NT5 ARS ; <br /> ARRANGED BY CALLING (249)468-0344. OFFICE HOMLS FOR :ARB SCHIDVLFsD ` ..: ' <br /> MONDAY THRU FRIDAY EXCLUDING HOLIDAYS, 8:00 .M..TO 12 oo:NOot AN$ ItW '.I4i:fi0 <br /> P.M. <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION AN 0 A NON•REFU, NDABIB DEPOSIT OF <br /> IS REQUIRED. DEPOSITS WILL BE RETURNED TO THE APPLICANT IF THE FILES/RECORDS AAE = <br /> NOT AVAMABLE WITHIN THE CUSTODY OF THE EHD. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPI-11313TOWARDS THE TOTAL FII.B REVIEW FEE <br /> CHARGE. THE BALANCE OF THE CHARGES ARE DUE ND PAYABLE Y TO REVIEWING}TkM <br /> DOCUMENT(S). <br /> S. PUBLIC FILES/RECORDS NOT RETURNED IN 1W SAME CONDYLION AS RECEIVED WILL BE <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT, ITUS ADDITIONAL '`> <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PA:IMENT. <br /> b. ORIGINAL PUBLIC Fum/RECORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> SIGNATURE OF APPLICANT 1 ---�1 , r. i DATE IZ12-ZgLl <br /> STGNATURE OF RELEASING OFmCTAL-.___ DATE <br /> CH 00 14 (REV 12/92) <br /> _�'d £65iZSat ;i_ WodJ Wd5£:TT £66T-9Z-80 <br />