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j:: <br /> SAN JOAQUIlY COUNTY lion >:•. <br /> O j PUBLIC HEALTH SERVICES �.�� 10 <br /> MEN - i <br /> ENVIRONTADIVISION FL HEALTH r <br /> PUBLIC RECORDS RELEASE APPLICATION �,{•i�LltD �J ` ''` <br /> PHONE NO <br /> gppI1CAN'I'y a.(1n. . &-n -- <br /> gs <br /> ADDRESS 23 c1r'• 5 <br /> AGENCY NAlvlE �2 �+- _. _PHONE NO _- <br /> ADDRESS <br /> 40 i.T3A AGENCY pA <br /> -. <br /> 35s14wla�- s�� (�(a ^�-� j <br /> Ca k7 a^ E ('hrt 5 <br /> a 1�zZ � • FLS S�. 43S3v <br /> a i <br /> r,(coo zxo fEm oratY =F <br /> o11011C 0 zY +k <br /> 7 0 �cl, rc3 a>v GcJ 1, <br /> ,M <br /> .1 <br /> 'q <br /> THIS NOTICE IS SUBJECT TO THE REQUIRBME <br /> IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICHSMOMON�TA'HEALTH DIVISION(EHD)P011C OLUTIONS�STATE�WA'I'�CODE OCO F SAN B <br /> JOAQUIN COUNTY, EHD FEE'S AND SERVICE CHARDS RBS <br /> GOVERNMENT CODS AND THE EVIDENCE CODE. <br /> 1, A MAXIMUM OF TSN (10) PREMISS ADDRESSES PER REQUEST. <br /> APPOINTMENT'S ARE <br /> Z, PUBLIC FILES/RECORDS REVIEW ARE BY ARE SCHEDULED <br /> ARRANGED BY CALLING (709)468-0340. OFFICE HOURS TOOR 12:00 NOON D 1:0o P.M. TO 4:30 <br /> MONDAY THRU FRIDAY EXCLUDING HOLIDAYS, 8. <br /> P.M. <br /> NON REP[7NDA DEPOSIT OF$7--- <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION AND A. <br /> IS REQUIRED. DEPOSITS WILL BE RETURNED TO THE APPLICANT IF THE FILES/RECORDS ARE ;r <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS E TOTAL REV�G�g A. <br /> CHARGE. THE BALANCE OF THE CFIARGES ARE DUE AN <br /> DOCUMENT(S). RECEIVED'WILL BE <br /> S. PUBLIC FII,BS/RECORDS NOT RETURNED IN SB H SAME <br /> OF THE ONDMON pppI1CANT S 'IHiO AL <br /> CORRECTED BY THE EHD STAFF AT THE I3XPEN <br /> SERVICE WILL- BE BRIM TO THE APPLICANT FOR PAYMENT. <br /> 5. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT BE REMOVED !?ROM THE!BID PREMISES. = <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> + DATE <br /> SIGNATURE OF RELEASING OFFICIAL <br /> EH 00 14 (REV 12192) ; <br /> t' <br /> .1 <br />