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• SAN JOAQUIN C(%UNT V i • _. <br /> PUBLIC HEALTH SLR\'IC `R <br /> EN VMQrq<MNTTAL IMALM DIVISION <br /> Cn <br /> pURl,iC RECORDS RELEASE AMUCATION <br /> CNl'L�,)f � . ry <br /> AITIIrANTLLiZ PRUNE NO <br /> ADMESS O yi., <br /> A0ENCY NA)NM' PHONE NO_la2z=e_ <br /> ADDRPSS_ , �� .. -- <br /> i11 n A�12ILliiS JT3n N .�• DAIL <br /> 16 ZL <br /> iaasf _ -- - . -- - — <br /> THIS NOTICE IS SUMCT TO TTI11 RPQ[)IRRMIINV% 111P-N'I1-PIED IN THE PIISUC HEALTH <br /> SER` ICESIENVTR ON) LHRAI.TIT TO YtSI(IN (UH 0)PUL .'Y PP74)M, ORMN ANCE CODE OF SAN <br /> lOAQLIIN COUNTY. PT:S ANTI cT.RVIIH <br /> :H C' AROE RESOLlYnONS, STATB WATTIA CODE, <br /> GOYERNMSNT THIi FVITIFNCIT T;UL711. <br /> I, �,Mn <br /> OF 1't!N (IU) PFENusE ADDRBSS18S PER P.EQUEST. <br /> 2. snal.cxlRll.v RBv1eW ARB BY AIZQR IT,4ENT zN - APPotNTMEN-TS ARE <br /> ARRAN b BY CAL ;LM)46K.AnM). OFFICE HOURS FOR APPOINTMENTS ARE SCNENALED <br /> MONDAY T1iRU FRIDAY PKI'LUUINO HOLIDAYS, 8'00 A.M. TO 12:00 NOON AND 1,00 P.M, TO 4:30 <br /> P.M. <br /> 3. A 1'LIUIJU RELOADS RELEASE APPLICATION AND A N-QN-RrTND B .R DSPOBTT OP S7A.11(1,,. <br /> IS p-piUMpa DCPnRTTS MIL BE RETURNED I O THE APPLICAN�IP THE FILR.rtfRPCORD$ ARH <br /> NOT A VNLABLE M1HIN THE CUSTODY OF THE EHD. <br /> 4. TIJR ABOVE IDENTIFTFD DEPOSIT IS APP11U.0 TOWARDS THE TOTAL FILE REVIEW PEE <br /> CHARGE, THE BALANCE OF TH2 CHARGPS AR DUE AND PAYABLE LWA TO REVIEWING Um <br /> DCCUI•SENT(S). <br /> J. P'JBUC MUSIRPCORDr NUY R1 II")RNED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRFCTFT) RX THE PHD STAFF AT THE EXPENSE OF THE APPLICANT. TM9 ADDITIONAL <br /> SE.RV1i'.L WILL HS BILLED TO THE APPLCANT FOR PAYMENT. , <br /> R. ORIUINAL PUBLIC FTIMS/RECORDS SHALL"IGT BB REMOVFI) FAf'M '11418 EHD PREMISES. <br /> ---------------- <br /> SIGNATURE OI' AFPI.ICA.NT _ DATE. <br /> SIGNATURE OF RELEASTNG OFFICIAL _—_ DATE <br /> EH 00 14 (REV IV92) <br /> t <br />