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�( ,( -VA <br /> /SAN JOAQ LJIN C TY ' <br /> PL`BLT.0 EF--A-LTH SERVICES <br /> FIv'VIRONME— TAL HEALTH DIVISION ,," 0 . ?r� <br /> �� l7 PUBLIC RECORDS RELEASE APPLICATION <br /> 'APPLICA.NT G �/ W-4L <br /> PHONE ISTO= <br /> ADDRESS t�- Q_ t SoT0�'. t 0113 <br /> AGElgCY NAME PHONE NO <br /> ADDRESS <br /> FILB A DR -w AQENCY DATE <br /> aoo <br /> Aila i <br /> 0 03 <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEAL-FA <br /> SERVICES/ENVIRO;',1,IENTAL HEALTH D►'�ISION (EI-10) POLICY„'92-007, ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EJiD FEES A-ND SERVICE CHARGE RESOLUTIONS, STATE- 'N'A-IT--R CODE, <br /> GOVERNMENT CODE AND 11-lE EVIDENCE CODE. <br /> 1. A MA�,j1,lUI i OF TEN, (10) PREINUSL: ADDRiSSES PER REQUEST. <br /> r <br /> 2. PUBLIC FILES/RECORDS REVIEW ARE BY APPOINTMENT ONLY. APPOINTMENTS ARE <br /> ARRANGED BY CALLING (209)468-0340. OFFICE; HOURS FOR APPOINTMENTS ARE SC14EDULED <br /> 1 ` MONDAY MRU FRIDAY EXCLUDING HOLIDAYS, 8:00 A.M. TO 12:00 NOON AND 1:00 P.M. TO 4:30 <br /> 3. A PUBLIC RECORDS RELEASE- APPLICATION AND A INON-REFUNDABLE DEPOSIT OF M-00 <br /> IS REQUTRED. DEPOSITS RILL BE RETURNED TO THE APPLICANT IF T142 1 LESiRECORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEW FEE <br /> CHARGE. T14E BALANCE- OF THE CHARGES ARE DUE AND PAYABLE PRIOR TO REVIE«'ING THE <br /> DOCUMENT(S). <br /> 5. PUBLIC F1LES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED FILL BE <br /> CORRECTED BY THE EHD STAFF AT T14E EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE RILL BE BILLED TO TI-1E APPLICA\1 FOR PAYMENT. <br /> b. ORIGINAL PUBLIC FILF&RECORDS SHALL NOT BE REMOVED FR <br /> OAi INE Eriv �„'.:,TcLc <br /> SIGNATURE OF APPLICANT _ � CQ- DA-IT-- <br /> SIGNATURE <br /> ATLSIGNATURE OF RELEASING OFFICIAL DATE <br /> of OO "4 (J-u-v 12/92) <br />