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S; iV j/-"AQUly COUyTYPUBLIC HCALI l-i `.1_R'r•10E3 <br /> afy"z^� `i:l � ;nD WRONMENTAL HEALTH DIWIS 4 <br /> - ' � '�' �' `�T" ' 304 EAST WEBER AVENUE,THIRD FLOOR, F { 1 <br /> STOCKTON GA 95202 •t��� <br /> NIAR 2 2 2001 (249) 468-3420 <br /> HPUBLIC RECORDS RELEASE APPLICATION <br /> Pt R%.IIT1 r. BUSINESSIAGENCY U <br /> APPLI <br /> s oad ockt.� says <br /> ONE ao 7 -7�I�! ~�Dl� FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE 1 Y � TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> P111CH BOX TO EXPEDITE REQUEST-$7 FEE- QUES R0CC;ESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE l <br /> 'FILE ADDRESS <br /> - --------�! Z t/FH�f <br /> 23 r a� -�s <br /> OrUG1 .fl C-- / S <br /> �(I <br /> 1 L <br /> ( kA n <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ___>XUNDE=RGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ 'SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> '❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SETES <br /> C2 ME=DICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 9. List up to ten addresses in the space above. Select the type(s) of files frorn,the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 249 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten ('10) days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments-should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. Anew <br /> application may be 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 <br /> of the applicant. Future'file reviews by the same applicant may require a $78.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> l CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES T NO REVIEW DATE <br /> Eii 00 14 01105100 - <br /> �� iii• i <br /> 1 <br />