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� � r <br /> SAN' OA UIN COUNTY <br /> J Q <br /> PUBI-IC HEALTH SERVICES / <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PUBLIC�RECORDS RELEASE APPLICATION/ <br /> APPLICANT SSU Z0 rI t P e����. '�i7 PHONE NO. -2 <br /> ADDRESS <br /> AGENCY NAME /1 i ! PHONE NO <br /> ADDRESS `ynN _ <br /> ME A.DDRES,� J-EAD AGENCY DATE <br /> /! <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED 114 THE PUBLIC MEAL-114 <br /> SUZVICES/ENV RONI.iENTAL I IEAL774 DIVISION (EHD) POLICY #92-007,ORDINAl:CI:CODE OF SAJd <br /> JOAQUIN COUNTY, E14D FEES AND SERVICE CHARGE RESOLUTIONS, STATE NATIER CODE, <br /> GOVERNMENT CODE AND TIFE EVIDENCE CODE- <br /> 1. A %fA,:T1.iUl,i OF TEN (Io) PRENUSE ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILES/RECORDS REVIEW APS BY APPOINTMENT Oh't_Y. APPOINTMENTS ARF- <br /> ARRANGED <br /> REARRANGED BY CALLING (9209)468-0340. OFFICE HOURS FOR APPOINnIENTS ARE SCHEDULED <br /> MONDAY TH}RU FRIDAY EXCLUDING HOLIDAYS, 8:00 A.M. TO 12:00 NOON .AND 1:00 P.M. TO 4:30 <br /> P.Nf- <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION AND A NON-REFUNDABLE DEPOSIT OF 578.00 <br /> IS REQUIRED. DEPOSITS WILL BE RETURNED TO THE APPLICANT IF THE FILM/RECORDS ARE <br /> NOT AVAILA.BLE W1TIBN THE CUSTODY OF THE F-HD. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEW FEE <br /> CHARGE. THE BALANCE OF THE CHARGES ARE DUE AND PAYABLE ERIOR TO REVIE-v'.ING TmE <br /> DOCUMENT(S). <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 TILE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO TME APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REN40V ED FROM T'14H EHD PR.ENBSES_ <br /> SIGNATURE OF A.PPLJCAN-r ��L. ,� DATE �^ <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 12192) <br />