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L'Ll -o�3p u w . <br /> SAN ►70AQUIN COUNTY <br /> VVBLIC RHALTH SERVICES <br /> EN VIROI MnaAL IMLTff D IVIS ION yX t0 , <br /> KMLIC RiRCORD9 1StELEASE APPLICATION <br /> APPLICANT D N tQ� - PWNH NO <br /> AGEWCY NAME PRONE NO i <br /> I�DRE3SS ' <br /> �rat*,b-kkieaYr*�F9rat�tdr:4#iFiriF�e�irffft*tir***fit:+tirYtir7e31httkswxyryr-r#tint#wvc*yF�itk*-k I <br /> FPLL ADQRAS HU8F1wT7d5S N P bC3RAM 4R <br /> FACILI� TYPE OF FILE <br /> a _ LIS <br /> o # <br /> *t*�r:Ir�tycyt�ki, RFRt4y►tkiF*'k#iF*t'k7k"kYlr'k�F*#*'*tk*!*ick##Y:�lirff'4�dr#�#ir#*1k�tfF�[�kF## <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMEM IDENTIFIED IN THE PUBLIC HEALTH <br /> SERWCESIENVI RON MENTAL HEALTH DIVISION ;EHN POLICY 984-047, ORDINANCE" CODE OF <br /> SAN JOAGUIN COUNTY, EHO FEE AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE, <br /> 1. A MAXIMUM OF 19M LIE PREMISE:ADDRESSES PER REQUEST <br /> 2. PUBLIC FILES/RrECORDS REVIEW 15 BY BeeQlNfTMENT ORLY. APPOINTMENTS ARE PROCESS- <br /> ED BY.CALLING i209KGS-WO. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED MONDAY <br /> THRU FRIDAY EXCLUDING HOLIDAYS, 5:00 AM TO 12:00 NEON AND 1.00 TO 4:30 PM. <br /> 3. A PUBLIC FILESIRECORM REBASE APPLICATION (PRPA) IS RECUIRED. <br /> 4. PIJBUC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL.BE <br /> CORRECTED BY THE EHD STAFF.AT THE EXPENSE OF THE APPLICANT, THIS ADDITIONAL <br /> SERVICE WILL BE 611LLM TO THE APPLICANT FOR PAYMENT. [SEE EH0 POLICY 94- 007) <br /> S. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE EMD PREMISES. <br /> +i.�ii.ay.st R-ttiF+at,���w�}r... �*ts.r�i�r�f� r;+• •assrrrt�+r.s;a.*+i+�F�..�xsi►ef <br /> SIGNATURE OF APPLICAN rDAiE <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> FH 00 14 (REV 9MG) <br /> lq <br /> TOTAL P.Q1 <br /> t <br /> 3. <br />