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7 <br /> SAN J O A QUIN C <br /> PUB I.?C HEALTH SERVICES ` <br /> HEALTH DIVISION �'i� ! 5 _��91-'r <br /> � F�v�YLROI�'I��'TAL 73 :•��� . J <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> UZG1VA' n @ �PJnd e Y'Sd I1 <br /> �a Q�� W-2 PHONE ISAPPLICANT � O ADDRESSf)t�S fv• wt 5oT�CKi OJIJ Cly Q�a��� <br /> AGENCY NAME PHONE NO <br /> ADDRESS <br /> FILH ADDRESS LEAD AGENCY DATE <br /> _ • SQh - <br /> aDn'7 <br /> C-1 I <br /> 701 <br /> Mf--71IU92.-- <br /> U D M�oxlc�l <br /> TI-US NOTICE IS SUBJECT TO THE KEQUIREMENTS IDENJIMED IN THE PUBLIC HEALTi-I <br /> SERVICF,S/ENVIRON}•1ENTAL HFALTH DIVISION (END) POUCY 4"92-007, ORDINANCE CODE OF SAN <br /> JOAQUIN COUNTY, EIID FEES AND SERVICE CHARGE RESOLUTIONS, STATE, W'A i ER CODE, <br /> GOVERNMENT CODE AND TEE EVIDENCE CODE. <br /> 1. A MA,JMUM OF TEN (10) PRENUSE ADDRESSES PER REQUEST. <br /> 2. PUBLIC FILES/RECORDS REVIEW ARE BY APPOINTMENT ONLY. APPOINTMENTS ARE <br /> '•�i ARRAIti'GED BY CALLING (209)4-68-0340. OFFICE, HOURS FOR APPOINT`1ENTS ARE SCHEDULED <br /> f ' ,MONDAY THRU FRIDAY EXCLUDING HOLIDAYS, 5:00 A.M. TO 12:00N OON AND 1:00 P.2 TO 4:30 <br /> P.M. <br /> 3. A PUBLIC RECORDS RELEASE APPLICATION AND A NO;N-RE;U;`DABLE DEPOSIT OF 575.00 <br /> IS REQ=--D. DEPOSITS FILL BE RL-I-URNED TO THE APPLICANT IF TI.IF- FILES tRECORDS ARE <br /> NOT AVAILABLE WITHIN THE CUSTODY OF THE EHD. <br /> 4. THE ABOVE ]DENTIFIED DEPOSIT 1S APPLIED TOWARDS THE TOTAL FILE REVIEW FEE <br /> CHARGE. THE BALA-\CE OF THE CHARGES ARE DUE AND PAYABLF_ PF.10R TO REVIENNING THE <br /> DOCUMENT(S). <br /> S. PUBLIC FILES/RECORDS NOT RLI-LTIR-NED IN THE SAME CONDITION AS RECEIVED WILL BE <br /> CORRE=--D BY THE EHD STAFF AT THE EXPENSE OF THE APPLICANT. THIS ADDITIONAL <br /> SERVICE WILL BE BiLLL-D TO TIIE- APPLICANT FOR PA"- iENT. <br /> 6. ORIGINAL PUBLIC FILES/RECORDS SHALL NOT 13F REMOVED FROM iii: E'ciD iE---- <br /> /R - <br /> SIGNATURE OF APPLICANT _ �/ � DATE <br /> SIGNATURE OF RELEASING OFFICIAL DATE <br /> Fj1 00 14 (RliV IJ97) <br />