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I I # I I . I :u I I I I . I . ... I . . <br />FEB -15-96 THU 14:29 <br />KLFISFELDER FAX NO. 2000'A" I P.02/02 <br />SAN JOi*SQTJ-W COUNTY I--, 1 0 <br />n -RUC ITEALMSERVICUS po-e- <br />r.,,NLVjR0N.MWi:NT&L HEALTH D(VISION <br />pU"gf,fC RFCopj)S RM' EASE jurlICAnON 031 <br />PHONE NO <br />CA- <br />Af)D.R.F-SS i - *-a �fc - <br />AGENCY <br />ADDRESS <br />FILE ADQ92 <br />5-5 <br />LEAD ACTENIC—y <br />11bJ c8-- <br />-nUS NO -RCE IS SUBJF-CT TO THE REQUMEMENTS MENTn'IF-D IN TKF T'MrIC TEEALUT <br />SolvicL-SiENVIF,(JNMENTALHEALDI rN (IUM) poflCy r)4-�, ORDENANCE CODE OF SAN <br />TOA.QTTTN COUNTy, Ea -M FEES AND SERVICE CRARG2 RF--5QLLrlloKS, STATE WATE"L CODE <br />coviRrimowr coDE AND mem EvIDENCIE c0DF-- <br />A Mk-,CN(T)M 00 --rVK (10) PPFI'USg ADDR&WO PER XF-(ZTJUT' <br />AmwrvM"47% r% ARRANGED <br />AR RANG 3 <br />2. ruBac Fiuism.EcoRDS REvl[Fw Is By <br />ONLY. 1 ' ] y <br />(:AIJ.JNCY (209)468-0340. OFRCE HOURS FOR APPONT-VEI'M ARE SCHEDULED MONDAY -XHRU FRIDA-r <br />ExcLuDwa HOU12. <br />IDAYS, 8-00 ANT70 .00 gooW Amn J.-Oo pm To 4:30 ?Nf.. <br />3. A PIMLIC FEcoRms RELEASE AFF=ATll0N (PMA) Is RYAUI"D. <br />4. MLIC JUjZSMrCoRDS NOT RrrUPNED IN TEE SAbM C0t4=VON AS RECE'VM WML Be CORRECTED <br />By THE Dij:) XrAff AT THE EXFENSE OF TIM APP=AKr. TSS ADDUM NAL Sr-RT=F- Wa.L BE BILLED To TIM <br />A PP13rANT FOR PATIVWNT. (SEE EEfD PoLicy 94-007) <br />5. ()pMIl4AL PUBLIC RIX-SIFECOFMS 31fAT-T- M)T- an RMAOVED FRCM TM ERD Mj7vUSM- <br />I <br />SIGNATT� OF APPLICANT <br />SIGNATURE OF RELEASING OFRCIAL <br />No PHS/EKD RECORDS/FiLms --xvrt MF-NTMW.D: <br />Op"m vimww .t: <br />DATE o4 – <br />M.lql!E�TD RF-coimsfFILES immE Cx'mtg ADDRgss(Es) tloozo. you wELL BE riOTEME)l wlEEN <br />jtXCoRpSjFtLF-3 ARE AVAICUARIJ? FOR )gtlVMW- <br />?*WVTC.TZW PAIM <br />