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02-04-1994 03:17 ,K FROM TO 14159782613 P,.02 I I <br /> ! rj <br /> COUNTY <br /> PUBLIC IS,A,1N,TOA VIN CO I I <br /> ' II� �HEALTH SERVICES <br /> EN'VMONMENTAL HEALM DIVISION <br /> CLIC RECORDS RELEASE APPLICATION <br /> APPLICANT r PHONE NO �!/ 4��j'- Aha p <br /> f ADDRESSI I,,�� , !- $r /�r+� F/car S" rlunas ro + Gi4 !os <br /> AGENCY N r <br /> ��lyKe/T PHONE NO <br /> ADDRI�SS d �%l; ---� <br /> I1 , <br /> FILE. ADDRESS ' LEAD AGENCY DATB <br /> CtJc�t�w <br /> � 7 <br /> 3b%n _3 - - <br /> I i M' <br /> I <br /> I Vii' i,l <br /> tI IJ i <br /> p <br /> , I I <br /> Np�� • F�� f u , gu i slog otysr s:/mss gag t l we s+ '✓i' i <br /> g rao <br /> THIS NOTICE I ' �SUBTECT TO THE REQUIREMENTS IDENTIFIED 10 THE PUBLIC HEALTH I "' <br /> .rc'rcC; <br /> SERVICES/EN �„ MENTAL HEALTH bIVISION(BIND)POLICY#92-007,ORDINANCE CODE OF SAN <br /> JOAQUIN COU , !EHD FEES AND SERVICE CHARGE RESOLUTION, STATE WATER COPE, <br /> GOVERNMENT EAND THE EVIDENCE CODE. <br /> I. A MA JC1 OF TEN(10) PREMISE ADDRESSES PER REQUFST. <br /> � <br /> ' 2. PU13LIC I /RECORDS REVIEW ARE BY APPO NTMENT ONLY. Al ARE <br /> 1 ARRANGED BY LING (209)468-0340. OFFICE HOURS FOR APPOINTMENTS ARfi SCHEDULED I i <br /> I MONDAY THRU IDAY EXCLUDING HOLIDAYS, 8:00 A.M.TO 12:00 NOON AND 1:00 P.M.TO 1:30 I I 1 i <br /> 4 P.M. I <br /> 3. A PUBU l ECORDS RELEASE APPLICATION AND A NON-REFUNDABLE DEPOSIT OF$7$.00 I <br /> IS REQUIRED, EPOSITS WILL BE RETURNED TO THE APPLICANT IF THE FILES/RECORDS ARE I <br /> I NOT AVAILABLE WTIHIN THE CUSTODY OF THE EHD. <br /> 4. THE ABC V IDENTIFIED DEPOSIT IS APPLIED TOWARDS THE TOTAL FILE REVIEW FEE j I <br /> CHARGE. THE B ANCB pF THE CHARGES ARE DUE AND PAYABLE MOR TO REVIEWING THE I I <br /> DOCUMENT(S). <br /> f \� 5. PUBLIC I IES/RECORDS NOT RETURNED IN THE SAM CONDITION AS RECEIVED WILL BE <br /> CORRECTED BY ,TIkIE EHD STAFF AT THE EXPENSE OF '1IiE APPLICANT. THIS ADllXTIONAL I I <br /> PP SERVICE WILL BE BILLED TO THE APPLICANT FOR PAYMENT. <br /> I; 6. ORIGINA�:, UPLIC FILES/RECORDS SHALL NOT BE REMOVED FROM THE EHD.PREMISES. I I <br /> I SIGNATURE OF P LICANT DATE <br /> I� I <br /> SIGNATURE OFRELEASING OFFICIAL DATE <br /> EH 00 14 (REV 1 / 2)-,.: <br /> TOTAL P.02 <br />