Laserfiche WebLink
-I-1 TL 14MZD P.02 <br />OL <br />qp <br />Ell 00 14 0MV 5194) SAN JOAQUIN COVATY <br />4 <br />PUBLIC HEALTH SERVICES <br />EN-MONMENTAL HEALTH DMSION <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICAMILipmKo �tl MATS"Kap-T. I 12W'�.jr, PHONME <br />ADDRESSa,Ac_ <br />AGENTCY NAME .---I%ONP- 140 <br />ADDRESS <br />Fll.E ADDRESS . LEAD AGENCY <br />WAM <br />a W —rail <br />THIS 1-40-1ICF IS SUBJECT TO THE REQUIREMENTS ID FI IN 77JU MBLIC 14EALTH <br />SERI'I','.'rVENVIRO&NME,N7ALliP.ALT14 DIVISION (EiHt)) POLICY #94-007, ORDINANCE CODE OF SAN <br />30A%QUT,'T COUNTY, F -RD FEES AND SERVICE CHARGE RESOLUTIONS, STATS WATF-R COD'u, <br />GOVERNMENT CODE AND 'IDIS EVII)ENCE CODE -i a I <br />i. A MAxthstim OF Tai (10) PkFmjsz AD0R888F_S M REQUEST. <br />'-1113LIC FTLUIRECORDS REVIEW is By APPOINTMENT 9N Y. AFponmiENTs AILS AmANGsDjoy <br />CALLING (209)468-0340. OFFICE HOURS FOR APPOINnISITM AU XCHWULIED MONDAY T U FkIID t <br />D list A <br />EXCLUIDJNG HOLIDAYS, 8:00 AN TO 12:OD NOW AND 1.1)0 ni To 4:30 pm. <br />3. A Puzuc REcoaps RELEASE AprL:jcA=N (PRRA) is nsQuwED. <br />4. PIMUC FILF—R/,Rr.COPDS NOT RirrukmED U4 TILE 3A"K CONDMON tS jtpcjRvIW WILL OF coaltWrED <br />BY TILE PPID sTAr-p AT TmE gxpramss of Ttle AppucANT. Tans ADDInONAL SERVICE WILL sa BiLLImm Tile <br />APPLICANT FOR PAYmetrr. (SEE ERD POLICT 94.007) <br />5. ORIGINAL PURL ic FILESfRED�r* N?T ay14OV15D TRONI Tag Ell D mamisas. <br />SIGNATURE OF APPLICANT DATE, <br />(SIGNATURE OF RELEASING OCT -ICTAL DATE CIS <br />No PHS.ENO Rr_coRDs1Fnzs ARE mammiso. <br />Ravnwm aw <br />r <br />PHSfEND 7IXORDS1FILES EXIST ON ME ADORM(F.S) t40•rw. You wnL n t4=FIED W11914 <br />R--CORDSIFILES An AVAILABLE P01t REVIEW: <br />tMtp RWACW= M. <br />