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fu xmolvwet)sju�b <br /> 84W JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> F24VIIROM41MAL HEALTH DIVISION <br /> rODUC RECORDS RF.LrASK APPLICATION <br /> AIPPI.ICArrrd a . °�.�' onrE NO ��•o��a 6- 00 <br /> ADDRISS 2 ? _Sr� Pit _6 <br /> AGENCYCl <br /> a,NAMH . l .3u rt 3PHONE NO Scutt <br /> .ADDRESS sQP <br /> AbDRfiSS �( DATA <br /> �' Qr Z`�S lr,. S���m 3 S•3o s 5 <br /> o e LL.? 3S a-4 rh^� ---- <br /> d «lri�crSa7 /lam nn <br /> AV.Fl 1ora A Sf� n•� �3S• 2-S- (k M <br /> 'moo d 5 Cbvr k.-,s?�-��� - 3 s •a lw-o- <br /> itrCO i 2o5- Al. C&.4w) Si` lei, <br /> TIRS NOnC$ IS SUWECI' TO T)IO REQUMMAM T3 II)EMIFI D LN THE PUBLIC RELALTH <br /> SE RVICT.9t6NVlR(?IM)5NTALHEALTH DlvmON(MD)POLICY 092-007.ORDINANCE CODE OP SAN <br /> .*QAQM CMNTV, ►BID FEM AND SMVICB CHARGE RESOLUTIONS. STATS WATER CODE, <br /> GOVERNMENT CODE AND T1m EVIDENCE CODs. <br /> I. A MAMMUM'Ole TEN (i0)PRBMi3F ADDR=29 rm ASQUES7: <br /> Z. PUBLIC 19L.EWRECORDS RUVWW ARE BY $ttQRflM3: ONLY. APPOINT161ENTS ARL <br /> ARRANGED BY CALLING M9WS-0340. ORRICE HOURS FOR ALI,B SCKBDULED <br /> MONDAY THRU FRIDAY rMCLUDING HOLIDAYS.8:00 A.M.TO [2:00 NOOK AND 1:00 FAL TO 4:30 <br /> P_hL <br /> 3. A PUBLIC RECORDS RELEASE AppLICATION AND A NQN-flUEBWABLE DRPO:UT OF$79.00 <br /> IS REQUIR MD. DEPOSITS WILL BFs PurlURNIiD TD'INE APplIcANT IF THIS PIIFmwoRDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE SM. <br /> 3. THE ABOVE IDECM9gD DEPOSTC IS APMED TOWARDS MM TOTAL FILE "VIEW IrEB <br /> MARM 7RE BALANCE OF IM aiAWES ARB DUE AND PAYABLE SRI TO REVIEWING TZIE <br /> DOCUMENT(S)- <br /> 5. PUBLIC P[L M"CORDS NOT R si�'IURNIU)IN THE SAME CONDITION AS RECEIVED WILL!?H <br /> CORRECTED BY TFM L°FID STAFF AT 'SHE MMMSE ()F -r"9 AMICAMr. TINTS ADDTIIONAL <br /> SF3RVICP-WILL BE.BILLED TO TIM APPLICANT FOR PAYMI3NT. <br /> 6. ORIGINAL PUB11C I'IL WRECORDS SHALL NOT BE RPMOVI.D PROM•niE EFiD PRSIbIISES. <br /> SIGNATURE OF APPLICANT DATE Z (o <br /> S.N.;IvATURF OF RE-PA.,,ll?,OTPICIAL DATE <br /> IBI 04 14(REV 12192) <br /> TOTAL F.02 <br />