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SA-4 JOAQU3N COLN""V <br /> PUBLIC HEAI.TI-X SERVICES <br /> &-,VjROItiT% N"TA_L RE.ALTIi IDMSION <br /> PUBLIC RJTCORDS RELEASE APPLICATION <br /> u�� t'}eR�etSor PHONE NO 209) 14(07- 100(o <br /> /.PPLICANI q_ <br /> ADDRESS_�— Rer. nrersten�e( PHOI-ffi NO <br /> AGENCY NAME <br /> ADDRESS -JILT <br /> > rl A <br /> DA1 <br /> A]7DIZL55 <br /> •-- <br /> 2�f _L_wn'�►f�Rod. _ �• �r s .; <br /> ZBSd l.eee+ts Rena _ � �.` <br /> 24 Fo Lee pot <br /> 2</41 Mari Prsa t7.� C&.) <br /> 2573 t•4 fi rsa «�— --_._--_.._- _. __.__. <br /> 375• • � - 'l <br /> T'H75 NO'1,CE IS SUEIECT TO THE REQUIREMENTS IDEN17F1CD )^i IIiL li,yu �-n{ <br /> SER%ICESlEN�FRON�sENTAL HEALTH Dlvi510N (EHD)POLICY 2-007, CRDINANL NATER COAL <br /> JOAQUIN COUtiTY, EIiD FS:S AND'SEA ICE CHARGE RL=S( LUTLO\S, STATE A^. <br /> GOVERNMENTCODE AND TrE EVIDENCE CODE. F <br /> I- A ',fA.'c7`•SU'•I or TEN (s0) PREN95E ADDRESSES PER REQUEST. <br /> 2. PUBLIC FIL"FSiRL'CC:�DS REVIE`,V ARE BY APPOINT'isL-`'T OtiLY. APPOINTMF14TS.'ARE <br /> ARRANGED BY CALLFNG (:�=)�S'03�a- OFT-ICE HOURS FOR APPOINTEE; N A� SCHEDULED <br /> MONDAY 7} RU FRIDAY EXCLUDING HOUDAYS, 3:00 A.Jf- TO 12.00 NOOV AND 1:00 P f <br /> rs <br /> 3. A PL'cLIC R< CORDS 1=LEASE,4PFUCA CIO`i A�'D.� \O\•REFI' DAGI.E DEPOSIT OF S7S 00 <br /> e� <br /> IS REQlS1RED. DEPOSFTS V,-,LL BE pM. 'BN);D TO THF APPFLCA4T IF THE- flLLSlx2ECORJJS ARE F c <br /> NOT AVAILABLE WIT34114 ii== CUSTODY OF TEE EHD. <br /> HE ABOVEVE ]DLt�T �:s D DEPOSIT IS APPLIED 1011'ARDS THE TOTAL FILE REVIEW FEE <br /> CHARGE_ THE B.AL,ANCE GF THE CHARGES ARE DUE.:..\D PAYABLE PRIOR TO REVIER'ING THE <br /> a. T <br /> DOCUNIF-NT(5). <br /> g. PUBLIC T 1LGS/EiECGRDS NOT R LIJRNED 1N THE SAISE CONDITION AS RECEIvED MLLBEY k <br /> COARE•CTEDBY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT_ THIS kDDlM AL <br /> SERVICP, \'VILE BE BILLED TO THE APPUCANC FOR PAY',y1&XT. : <br /> 6. ORIGINAL PUBLIC Fl FSiRECORDS SliALL NOT EE REMOVED FRON'-nlE Eli FRE.'�f3SLS _ <br /> DATE <br /> SIGNATURE OF APPLICANTfo —���y DATE <br /> SIGNATURE OF RELEASI\G OFIICIAL i ' <br /> EH 00 14 lRFV 12/90 <br />