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5 AIV J O AQL'IN C �17Y 1 . <br /> PU-B I,T.C HEALTH S ER ti 1 C ES <br /> ' <br /> i \ ( �i �i <br /> I2., RONNIF-N L HEALTH DIVISION ;NQ�, 0 5 <br /> PL-I3LIC RECORDS RELEASE APPLICATION <br /> {� �-7 <br /> j 'APPLICANP �Ct�1��I� r inmP_&4L'I3ONE NO� <br /> i ADDxrsS__(t p0 5 11j• l,t�I L so cL k �(�G4 N9�a� <br /> AGENCY NAl'�> r <br /> ADDRESS <br /> ILB ADDREL 5 BEAD .AGENCY DATE <br /> 1 X15 <br /> so" �(— <br /> ao� - <br /> a � kV <br /> f <br /> TI-IJS NOTICE IS SUBJECT TO THE REQUIP,.EMENTS IDENTIFIED IN T14E PUBLIC HEALiri <br /> SERVICFS/ENVIRONI.IENTAL HEALTH Di'IS10N (EHD) POUCY 6'92-007, ORDINANCE CODE OF SAN <br /> JOAQUIN COUN►Y, SID rg�_.A'D'D SER:ICE C14ARGE--R-F.SGL_LiTiOtiS. STATE WATER CODE, <br /> GOVERNMENT CODE AND iris EVIDENCE CODE. <br /> 1. A MAU,\11jA1 OF -IT-,,,, (10) PRL-MUSE ADDRE-SSES PER REQUT-ST. <br /> 2. PUBLIC FILES/RECORDS REVIEW ARE BY APPOINTMENT ONLY. APPOINTMENTS ARE <br /> ARRANGED BY CALUNG (200468-0340. OFT ICE HOURS FOR AFPOINT•tENTS ARE SCI4EDULLD <br /> A <br /> i MONDAY T-IRU FRIDAY EXCLUDING HOUDAYS, 8:00 A.M. TO 12:00 NOON AND 1:00 P.S1. TO 4:30 <br /> P.M. <br /> 3. A PUBLIC RECORDS PELEASE APPUCATON AND A NON-REFUNDABLE DEPOSIT OF 578.00 <br /> IS REQLZR.ED. DEPOSITS HILL BE RETURNED TO TIE APPUCA`T IF THE FILES/RECORDS A-KT <br /> NOT AVA]LAELE «ITJUN TI4E CUSTODY OF TIIL- El4D. <br /> 4. THE ABOVE IDENTIFIED DEPOSIT 15 APPL1E-D TOWARDS THE TOTAL FILE REVIEW FEE <br /> CHARGE. TIE BALANCE OF THE CHARGES ARE DUE AND PAYA-BLE_ P TJOR TO REVIEVING THE <br /> DOCUMENT(S). <br /> 5. PUBLIC FILES/FZECORDS NOT RETURNED 11N TIE- SAME CONDITION AS RECEiVE-D «'ILL PsF <br /> CORRECTED BY THE EHD STAFF AT THE EXPENSE OF T-IE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BILLED TO 'ME APPUCANT FOR PA YT1ENT. <br /> ,-. nr�r_�itC1=C <br /> 6. ORIGINAL PUBLIC FILL-SIRECORDS SHALL NOT BE REMOVED I ROM TI1i; i=tiL i..`.•-._ _. <br /> SIGNATURE OF APPLICANT _ DAiIr <br /> SIGNATURE OF RELEASING OFMCIAL DATE <br /> Eli 00 14 (REV 12/0%) <br />