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SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> &NVIRoNMENTAL HEALTH DIVISION <br /> jUHLIC RECORDS RELEASE APPLICATION <br /> APPLICANT PHONE NO <br /> ADDRESS <br /> AGENCY NAME PHONE NO 7111 <br /> ADDRESS Ale' ( "/1 2`22/9 - .3F-0-i <br /> FaX ADDRESS LEAD-Ar-ENrY D <br /> �71 llqladt�lkt ijil")II)c <br /> AA, <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION(EM POLICY#92-007.ORDINANCE CODE OF SAN <br /> JOAQUIN COUN'T'Y, E14D FEES AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE. <br /> GOVERNM[ENT CODE t D THE EVIDENCE CODE. <br /> 1. puBLjc Fa.EslkEcoRDs RF-viEw ARE i3y APPOINT ymNT OUL Y. ApPoDrrmmus App- <br /> ARRANGED BY CALLING (209)468-0340. OFFICE HOURS FOR APPODrrMIENTS ARE SCHEDULED <br /> MONDAY THRU FRIDAY EXCLUDING HOLIDAYS, 9:00 A.M. TO 12:00 NOON AND 1:00 P.M. TO 4:30 <br /> P.M. I <br /> 2. A PUBLIC "CORDS RELEASE APPLICATION ANDA DEPOSIT OF <br /> IS REQUIRED. DEPOSITS WILL BE RETURNED TO THE APPLICANT IF THE FamtREcoRDs ARE <br /> NOT AVAILABLE WITHIN'THE CUSTODY OF THE EBD. <br /> 3. THE ABOVE ID I ENTIFIRD DEPOSIT IS APPLIED TOWARDS THE TOTAL FII.E REVIEW FEE <br /> CHARGE. THE BALAN I CE OF THE CHARGES ARE DUE AND PAYABLE PRIO TO REVIEWING THE <br /> DOCUMENT(S). 1 <br /> 4. MUC FEUS�EC,()US NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL 9E <br /> CORRECTED By THE ERD STAFF AT THE WENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BUiED TO THE APPLICANT FOR PAYMENT. <br /> S. ORIGINAL PUBLIC FU-MfRECORDS SHALL NOT BE REMOVED FROM THE EM PREMISES.PRESES. <br /> c� <br /> SIGNATURE OF APPLICANT DATE <br /> # <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> ER 00 14 (REV 10/92) <br />