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12/20/2011 ~16:27 19345174 WGR SOUTHWEST INC PA E <br /> E LO t <br /> E UIN COUNTY " <br /> SANJQA4 <br /> C 2 0 2U�1 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, GA 95202-3029 <br /> • Ri tflNMENTALNEA ' phone, (209)4683420 Fax: (209) 464-0138 Web: www.sjgov,0rg/ehd <br /> mzPuTISERVICES /A/V J �"v <br /> U(BLIC RECORDS RELEASE,APPLICATION <br /> APPLICANT: �'/�- S'u i �` BUSINESS/AGENCY: Ems.v. rL, ` <br /> ADDRESS: Sf� ice/. P, . �e 54-,.., f7-'e, 6 CITYISTATEOP: _0 04 C F'r <br /> PHONE(1): (0 09) 3 3 "f-5_Y63 xz`PHONE(2): - ---` _ FACSIMILE; <br /> TENTATIVE*APPOINTMENT DATE: �A M `f Z,) 12, Time: Lx ( k, � <br /> (Please allow 10 buslness days from date of applicatl n sunmittal-*Tentatfvc only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUES '125 FEE(CASH OR CH_ oNLY)-REQUEST PROCESSED IN 3 BUS NESS AYS <br /> SIGNATURE OF APPLICANT DA' ( r If <br /> Electronic Information: ❑ List❑ Map-Pescriptiow <br /> FILE ADDRESS EHD use ONLY <br /> Street# Stroct Name City ❑ Unit 1 <br /> [2. <br /> G 7' dSra�atic� ���(-� Ave- - ❑unitz <br /> i. -0 `1 -1A /�;, .arLk (tea r l A <br /> 4. hyo F> - G.I(3 J ^� o ic +r �rt-. a, _^ Unit <br /> 5. P p A <br /> - Jt1 Gl5C1Yli��lQoo���� vJ <br /> 6. $ 1 O C';I,�,.+o r-�. ���✓c. , �� Unit 4 <br /> 7. <br /> $ Unit 5 <br /> 9. - <br /> m10. unit 6 <br /> Specific Date Range of Information kequested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> &UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOUSING ABATEMENT OLID WASTE FACILITYII/EHICLF <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WW/STF TIRE <br /> �Tww) <br /> NDERGROUND TANK(MONITORINGIREMOIIA4) ©pOG KENNEL [j DAIRY <br /> AZARDOUS WASTE GENERATOR 171 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> 0 TATTOOISODY PIERCING ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY$:00 AM-5:001PM(EXCLUDING HOLIDAYS) <br /> 1. List ug to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At(east one File type MUST be selected. Fax to(209)4840138 or mail to the 2L]dress indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD, Applications received after <br /> 3:00 prn will be processed the next business day. <br /> 2. The EHD will notify the applicant If any EHO tiles exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3, A file that is actively being worked on by EHD staff may not be Immediately available for review. A new application may be <br /> submitted when the file Is available. <br /> 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> I,'H 1 UhCi ONLY <br /> • <br /> 8/1191 <br /> EHD 48.00 <br />