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ot�aTanb <br /> Zruchiny., <br /> cs) <br /> DARIO L. DeBENEDMI <br /> (209)369-2507 FAX(209)367-5630 <br /> 19501 N. HWY. 99. ACAMPO, CA 95220 JOAQUIN COUNTY <br /> C HEALTH SERVICES <br /> + .. -.'NTAL HEALTH DIVISION <br /> PUBLIC RECORDS RELEASE APPLICATION. <br /> APPLICANT � i r y�C PHONE NO �_25 7 <br /> ADDRESS_j 6blrj <br /> AGENCY NAME T ADDRESS PHONE NO <br /> FULL ADDRESS BUSINESS NAME PROGRAM OR r <br /> FACILITY TYPE OF FILE <br /> CtA <br /> THIS NOTICE IS SUBJECT TO THE REQUIREMENTS IDENTIFIED IN THE PUBLIC HEALTH <br /> SERVICES/ENVIRONMENTAL HEALTH DIVISION 1EHD) POLICY #94-007, ORDINANCE CODE OF <br /> SAN JOAQUIN COUNTY, EHD FEE AND SERVICE CHARGE RESOLUTIONS, STATE WATER CODE, <br /> GOVERNMENT CODE AND THE EVIDENCE CODE. <br /> 1. A MAXIMUM OF TEN (101 PREMISE ADDRESSES PER REQUEST <br /> 2. PUBLIC FILES/RECORDS REVIEW IS BY APPOINTMENT ONLY, APPOINTMENTS ARE PROCESS- <br /> ED BY CALLING 1209)468-3420. OFFICE HOURS FOR APPOINTMENTS ARE SCHEDULED MONDAY <br /> THRU FRIDAY EXCLUDING HOLIDAYS, 8:00 AM TO 12:00 NOON AND 1:00 TO 4:30 PM. <br /> 3. A PUBLIC FILES/RECORDS RELEASE APPLICATION (PRRA) IS REQUIRED. <br /> 4. PUBLIC FILES/RECORDS NOT RETURNED IN THE SAME CONDITION AS RECEIVED WILL BE , <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. (SEE EHD POLICY 94- 007) <br /> 5. ORIGINAL PUBLIC FILESI 70 DS SHALL NOT BERE OVED FROM THE EHD PREMISES. <br /> SIGNATURE OF APPLICANT DATE_LZ�S-��p <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> EH 00 14 (REV 9196) <br />