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I-)�-1 ski .3:1',�F't•1 rnln�• vlt= i vv cu.� ......... .......,.. _ - �Y(���.� - . <br /> SAN JOAQUIN COUNTY G��j / o 6 <br /> PUBIJC HEALTH SERVICES <br /> ENYIItoNMGE14TAL HEALTH DIVISION <br /> PTJBLIC,RECORDS RELEASE APPLICATION <br /> APPLICANT t -' 010NE NO <br /> ADDRESS PHONE NO^ <br /> AGENCY NAMIR - <br /> ADDRESS <br /> FILE ADDEMS LEAD A iF1VCY DAT`S <br /> It <br /> 0 <br /> TRIS NOTICE IS SUI3AECT TO THIS REQUIREBICNTS IDEr Trn 7ED IN TALI PUBLIC HEAL'T'H <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION(F tlD)POLICY k92-M7,ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, ElID FFES AND SERVICE CHARGE RMLLMONS, STATE WATER CODE. <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> !. A MAXIMUM OF TEN(10)PREMISE ADDRESSES PER REQUEST. <br /> 7, pI18LIC Fit-ES/RF-CORDS RF.VIL:W ARE BY Ay ) j�TM .NT O�tI Y. APPOINTMENTS ARE <br /> ARRANGED BY CALLING (209)468-034()• OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED <br /> MONDAY THRU FRIDAY EXCLUDINO HOLIDAYS,B:OQ A-M.TO 12:00 NOUN AND I:W P.M.TO 4:30 <br /> P.M. <br /> Non <br /> EEU_ <br /> 0 Dr <br /> A ED. DEPOSr S WILL.. 09 RETURNED HE is <br /> 3. TAPPLICANT TTNE PIL EVRECORDS7AR <br /> IS REQU1EtH ' <br /> NOT AvAILABLB WITHIN THE CUSTODY OF THE EHD. <br /> 4. OTAL <br /> LE <br /> TILE ARINCE OF THfi CHARGES ARE UE AND PS APPLIED AYABLE PIREVIEW <br /> RIOR TOREVIEWI <br /> FEE <br /> C THE <br /> CHARGE. 'fHE BABA LAN <br /> DOCUMEMRS). <br /> IN THIS SAME CONDIIION <br /> ECt <br /> 1_ EHD STAFF AT THENEXPENSE OF THE APPLICANTS R <br /> CTHISI <br /> Vr <br /> 5. PUBLIC F1ADDITIONAL <br /> ORRECTEr3 13Y THE HB <br /> SERVICE WILT.HE BILLED TO THE APPLICANT FOR PAYMENT. <br /> 6. ORIGINAL PUBLIC FILESI"CORDS SHALL NOT BE REMOVED FROM THE EHD PREMISES. <br /> SIGNATURE OF APPLICANT RAT& <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14(REV 12192) <br /> h�,G Iq�r <br /> i�tRv <br />