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�p-a <br /> SAN JOAQtTJN COUNTY <br /> r� �-��, mBuc BzALTH S�vTCES <br /> x�eENvMOrm�rrrAL sEALTH D"ION <br /> LIC RECORDS RELLASE APPLICATION <br /> APrucAxr S��n MON$ NO 9) 4167-_oq <br /> ADDRESS <br /> AGENCY NAME t1 1C FHONI? NO <br /> ADIDRESS �1 <br /> -41I 5tact^�au` LEAD ACF�ICY DATE <br /> EM AD RF55 <br /> 3 la <br /> t/03 S. C <br /> 00 v 5 <br /> r - - <br /> `t S e. - _ <br /> r,rx,n� <br /> -�- e Y-' <br /> r ST 7 <br /> THIS NO"IICE IS SUBJECT TO THE R.EQUIRENIENTS IDENTIFIED IN T'HE PUBLIC HEALTId <br /> eERVLCLS/ENVMONhlENTAL HEALTH DIVISION(EHD)POLICY x'92-007,ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, FJ4D FEES AND SERVICE CHARGE RESOLUTIONS. SPATE A'ATnt CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE <br /> 1. A MA)QbiUbi OF TEN (10) PREI�`IISE ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILES/RECORDS REVIEW ARE BY APPOI;`'TMENT OI~'LY. APPOINTMENTS ARE <br /> ARRANGED BY CALLING (20q)4.63-0340. OFFICE HOURS FOR APPOINniENTS ARE SCHEDULED <br /> MONDAY THRU FRIDAY EXCLUDING 14OLlDAYS, 8:00 A.M. TO 12:00 NOON AND 1:00 TO 4:30 <br /> P.N1. <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION AND A NOTNI-REFUNDA@L_I<DEPOSIT OF$78.00 <br /> IS REQUIRED. DEPOSIT'Sw7LL BE RETURNED TO THE APPLICANT IF THE FILES/RECORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. <br /> 4. THE A13OVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE MVIEW FEE <br /> CHARGE. THE BALANCE OF THE CHARGES ARE DUE AND PAYABLE� <br /> R_TO REVIEWING THE <br /> DOCUMENT(S). <br /> S. PUBLIC FILESM-ECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED NTLI.BE <br /> CORRECTED BY T1 F_ END STAFF AT TIRE EXPENSE OF THH APPLICANT. THIS ADDITIONAL <br /> SERVICE WILD..BE BI LED To THE A-PXlICANT FOR PAYMENT. <br /> b. ORIGINAL PUBLIC FILECORDS-HALL-NOT BE REI+ <br /> zsntiOVED FROM THE EHD FREWSES. <br /> SIGNATURE OF APPLIC �fl/ DATE <br /> SIGNATURE OFR__kSLNG 0 CIAL DATE <br /> 7W <br /> EH 00 14 (REV 17192) <br />