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�x�eaLle <br /> . SAN JOAQUIN COUNTY <br /> ��- <br /> 009 <br /> I >C > .TH SERVICES <br /> NyiRQ �IFXpe NTAL HEALTH DMSION <br /> LIC RECORDS RELEASE APPLICATION <br /> APpucANr &u Zarin 2 a �� _P>iloNa No�aoo ZL17-IQ <br /> ADDRESS <br /> AGENCY NAME <br /> �� F �PHO�NP-- O <br /> ADDRESS r- <br /> -411 STacY�e� ` t EAD AG—F-N-CY DATE <br /> FILE ADDRESS <br /> lo �Q _ <br /> `f p �' f� - <br /> 43 S. C 2 �� <br /> 0o u s - <br /> IL <br /> ~r <br /> r all 0 <br /> -I- - <br /> TI_US NOTICE IS SUHIECT TO THE REIR <br /> QUEMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERV]CESIENVMONMENTAL HEALTH DIVISION (END) POUCY x92.007, ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, Fi1D FEES AND SERVICE CHARGE RESOLUTIONS. STATE WATER CODE, <br /> GOVI?tNM NT CODE AND TAS EVIDENCE CODE. <br /> 1. A MA>aMUNI OF TEN (10) PRF?`iJSE .ADDRESSES PER REQUEST. <br /> 2. PUBUC FILES/RECORDS RF.,Onw ARF BY APFO(NTTIENT ONLY. APPOINTMENTS AF,- <br /> ARRANGED BY CALUNG (209)469-0340. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br /> MONDAY THRU FRIDAY EXCLUDING HOLIDAYS, 8:00 A.N1. TO 12:00 NOON AND 1:00 P.I.J. TO 4:30 <br /> P.)4. <br /> 3. A PUBLIC RECORDS RZLEASE APPLICATION AND ASO l�'- EFUI`DABLE DF-POSIT OF 578.00 <br /> IS R1 QUIRED. DEPOSITS alLL BE RETURNED TO 'I.-4E ,kPFUCANT IF THE FILES/R£CORDS ARE <br /> NOT AVAILA-BLE WITHIN THE CUSTODY OF TI4E F11D. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS A.PPL]FD TOWARDS THE TOTAL FILE RFVIF-W FEE <br /> CHARGE. THE BAIANCE OF THE CHARGES ARF DUE AND PAYABLE Rp�QR TO REVIEWING THE <br /> DOCUMENT(S). <br /> 5. PUBLIC FILFs[RECORDS NOT RF.TUR_NF-D IN THE SAME CONDITION AS RECEIVED WILL BE <br /> COR3tE(.'TI=D I3Y THE EI4D STAFF AT THE EXPENSE OF T 4H ,ApPUCjkNT. THIS ADDITIONAL <br /> SERVICE WILL BE BILL.En TO TI4E APl?LICANT-FOR PAY\IF-NT. <br /> 6. ORIGINAL PUBLIC FIL.FSlRFCORDS SHALL.NOT BE REMOVED FROM THE EHD PREMISES. <br /> nn� DATE <br /> SIGNATURE OF APPUCANT _ L1/j� - <br /> SIGNATURE OF RELEASING 0 CIAL DATE <br /> EH 00 14 (RJ---v 12!92) <br />