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SAN JpAQUMN COUNTY <br /> .A <br /> PUBLIC HEALTH S>vRYXCES <br /> I3 <br /> rrvMalvr�'. r- HEALTH DMIST:v { <br /> CLIC RECORDS RELEASE APPIICA1"I0N. <br /> PHONE N4 ; <br /> APPLICANr�Cu 15d <br /> ADDRESS j.o >��/lva�'1�i}•�'l a PHONE NO � f`�r� - <br /> AGENCY NAME mvl c � <br /> ADDRESS t go vV, t?a rr Ln.• f fir' S oc a "' <br /> EMADDRES� <br /> EN DATE <br /> Z /.erg PA;g <br /> THIS NOTICI± ISS SUBJECT To THE: 1`14E PUBLIC HEALTH :.'. <br /> S V10ESlEIvVIRO,i il~�`TAL.jF- LTA DIVISIa;I(END]POLICY;"42-007,CRllC!�AI�CE CODE OF <br /> JOAQUIN COUNTY, END FEES A,`D SI=RN'ICC CIRARGE g�OL•UTIO\S, STATE WATER CODE,, <br /> GOVERNNiENT COAT AND Tr.E EVIDENCE CODE. ; <br /> I. A NIA:0NIUbi OF TEN (10)PRallSE ADDRESSES PER REQUEST. ; <br /> Z. PUBLIC FILFSIRSCORDS REVIMV ARE'BY APY4L <br /> VT Ol3LY, APPQIZ`T'vCENTS ARE <br /> ARRANGED BY CALLING (:09)4634340. , CFFCCE HOURS FOR llpl'OT;2ni iEINTS .iR£ SCIl>~DULED AN <br /> tD DAY THRl9 FRIDAY Ecct af:.G IiOL'DAYS, 8:40 A.ai. TO 13:40 Oo;I AND i:l p.ri. To 4:30 _. <br /> P.1%1. <br /> A I'UI3LIC!t--CORDS PLEASE A.PPUCATION A. D A h'Q'-I• ' ' Ai3LE DEPOSIT OF 578.00 <br /> ;S RF{ UIREI]. DEPOSITS W11-1 BE RE[UIL' ED TO THE APPLICA4T IF THE r-ILF-SlRECORDS ARE . <br /> ,ti QT AVA]) BLE'M'T .4 TH=- CUSTODY OF THE EHD. <br /> EW FEE, <br /> 4. TILE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS TN>= RQ�ATO FYI�v11�IG 7HE <br /> CHARGE.. THE BALANCE OF THE C14ARGES ARE DUE AND PAYAI3Z.E�� <br /> DOC[J Ad E NT(S). <br /> 5. PUBLIC E'ILESlRECORDS I40T FLETUE\ Dl'ITN IN <br /> THE APPLICAJ�T.S ED WILL BE' <br /> RTi1SI`ADDMO AL- <br /> CORRECTED BY TRE END STAFF AT T}I <br /> SERVICE WILL BE BILLED TO THE APPUCANT FOR FAYA!ENT. <br /> b. ORIGINAL PUBLIC FILEsAUCORDS SHALL NOT BE MtOVED FROM THE E}1D PREMISES.' <br /> SIGIIATUFuE OF APPLICANT' am.�.r /1r� t _ DATE <br /> •�• _. <br /> SIGNATURE OFRELEASING OFFICIAL DATE <br /> EA 00 14 (REV 12192) <br />