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lZ3_2 <br /> z�1•d �rJLDI �Clu:{. �w <br /> SAN JOAQUINCOUNTY <br /> runmC IWAILTIt SIERVICaWS <br /> F.NVYILONME14TAL HEALTH D"TON <br /> PURLIC R&CORDB RELEASE AI'I'L1 A770N <br /> APPMANT .l,sv 1�C S i �(� LD PII(AVII N(7� L <br /> AIWRM Z D`O L; lAd 4+ 1 (+ 'j5-7, ,'5r) <br /> AGAKCY NAME PHONII NO <br /> ADDREM <br /> rlli.8�!?ll>ZES5 LUAI] A(M CX DATA <br /> l ...r�. )J. <br /> PA ' -LiW ,3 er�` Sce 1n )n b �YV S <br /> THIS N[Ill(:E IS SUBJECT TO THE )(RQUIREMIENIS TDENJIMW IN THE P LIC HEAL'1Tl <br /> SBRVICFx MMIRONI, ENTALliEAL711 DIVISION(MID)POLcY 0,#7,W,ORLI NAN CODE OP SCAN <br /> JOAQUIN COUNTY, FED PFWS, AND SPRVICS CHARGE RZOLD•IIONS, SCATH WATM CODE, <br /> OVVbKNM1?NT CODE AND Mo EVIDHNCB CODE. <br /> I. A MA.CJMUM OF TEN (19 PREMISE A]7URS3 M FER REQUEST. <br /> 2. I'UBLR' FILESWCORDB RSVDiW ARE UY 6P ANlhi0NL9MX, AFFOXITIMENTS ARE <br /> ARRANOI31) EY CAU-ING MW OFFICE HOURS FOR '�'P TM RNTS AF H SCHP]JULLD <br /> MONDAY THRU PRII)AY E(CI UDINO HOIJDAYH,e:W A.M.TO:12' NOON AND U 30 P.M.TO 4:30 <br /> P.M <br /> 3. A PUBLIC FXCOROS R.M.PASR APPY KATION ANDA D SIT OPS76.OP <br /> IS REQUIRED. DEM." WIIL BS RMXJRNED TO THf3 AI'VUCANT IF-IIB FII]IS ECOIUsk ARE <br /> NOT AVAILABYX W"W N THE CUSPDDY OP THE BUD. <br /> 4. THE ABOVE IDWDPjFD DEPOSIT IS AFMIED TUWARUS THE TOTAL FD3i RRVIBW FEB <br /> CHAR138, THE HALANCE OF THE CHARGES ARE DUH AND PAYAbLS 'j,$Ifj$TO RSVIHWINO TLM <br /> mYCUMENTIS). <br /> 1. PUBLIC irom/RECORDS NOT RETURNED IN THS SAMB( E)nION A3 RHCEIVCD WILL AB <br /> C(Ri RIR-IRD BY THE EM STAFF AT THS EXPENSE OF TTW APPLICANT. THIS ADDITIONAL <br /> SESRVI( t Wl[]. <br /> BE HU.11'D TO]TIE APFLICANT POR PAYMENT. <br /> 6, ORI( MAL PUBLIC PJLE81RECORDS SHALL NOT BE REKOVSD FROM THE I RID Mu"ISS3. <br /> SIVNATTIR$OFA"lJCANF L- ~� DATE <br /> SIONATIJRB OCRRLBAWN0 OFFICIAL DATA <br /> FI1 OV 14 (REV 12192) <br /> I <br /> r_�'d 1•TGZRG3T DL wUHd WdFs,.10 rgvT-HR n <br />