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04-iS-2001 08:S AM---e 1`�I Tt] 19259dC�3� P.01 <br /> Q J 4 ke0a,t6 ;-- :- � LW LUci Nunukm <br /> Sir.7DAQt11N COUNTY <br /> PUSUC HEALTH-* RVLCE <br /> i;NVIR0l1 MENTAL HEALTH DIVISION � (� /} <br /> : wEBIE R AvrikuEt THIPJ) FLOOR j� <br /> A 7 Z 0 0 i 304 EAST STOCKTC?N GA 96202 <br /> tir ,;,, ,_ ,I . f (209)jm IQ0 <br /> <<f� i; . . _FV ; :�� �.H NBLIC RECORDS RELEASE APPLICATION <br /> I ._ ...... _ r�rr,rl.ealllmrrsgAer�r�ryq�l����\wd YY�r�.�1A�q.AYa®I�/A7'11I <br /> Y J_# L e��i� C?&q j"#/if�uSle"eaar�N�cy (i�v C r x/ If 97IIS 14 4 <br /> API'L.IGAf�7 _ � ,. ... <br /> ADDRESS ��1� � 1..q� ��f�S`' �� �• S�I• '2 0� -- - ..�..... <br /> - -- ,fit} <br /> TENTATIVE"APE'OINE{Nr DATEI 71kC8 __ 9 _0!v <br /> (Plw"e pivs 7 to 14 buslnaas days#rpm date of■pplrcation Oubmittsl) <br /> CHIECK SOX YO EXPEDITE REQUEST 7.00 FEE-REQUE 7 PRQC�SSED 9 Bit ?IES S DAYS <br /> SIGNATURIa OF APPLICANT . � DATE <br /> 4 <br /> i <br /> FILE ADDRE33 THIS SIDE:CCD STAFF OU ONLY <br /> PROGRAM SL EMENTS BZARGH <br /> r L 0 Q -- <br /> ZOfZ CH4rX0&gC' { o21! 2 _3s 7.vk1 <br /> Acyc 4-V06 '95 I <br /> 9 9: - <br /> a C Ae T, <br /> r Iq C VLAI <br /> 2 2K CA TO <br /> z e - <br /> 4 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> i UW NDERQROUND TANK(usT)Ci..muP SITE(LAP) ❑ 14OUSINO ABAATENENT SOLID WASTE FAGILMY <br /> Y TNfR CLEfAH(1P SI tIO�I OPI — E] FOC]A FApCCt Y ❑ SOLib WA rE VSHICLE <br /> NOERGROUND (kiONITORIN RE;,IN <br /> ,14AZARDOUS WA37M QENW?ATQR m cmKEN RAkcm G PKG TRFATMENTpW4T <br /> [8'EERED PERIUTTFA FACUJW ❑ UOTE HOI_E`L CJ PUMPER TRI1CWyAjiGl HEM-FOELM <br /> � JA Qp►$ODY PELRCl4G 0 POQLJSPA k Ci LAND uaE APPUCA*ION WrEa <br /> p'M D3CdL %TF FAt�uTY 0 PUBLIC WATER SYSTEM ❑ 0TH R(Pt.EASR 3PL*C1FY ABOVE) <br /> I List up to ten addra.*ses In the space above. Select the type(&)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Eax to MR)HM132 or nad W the <br /> 2. EHO will notify th4 applicant if any EHO filee exist. An appointment for review will be confirmed <br /> approximately five Imsiness days but no later than ten(11D) days aftar rBeelpt Of application. The files <br /> will be hold for a maxirnum of two bustne"days`far review. Appointments should be aChaduled <br /> accordingly. <br /> 3. A fit*that is actively toeing worked on by EHD staff may not baa Immediately avallablse for review. A now <br /> application maybe sulanritted when the file is avallable. <br /> 4. Any tis not returned in the same condition as released will be reorganized by EHO staff At the expen" <br /> of the applicant. Future file reviews by the same applicant may reciulra a$87.04 dopaslt prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmad with EHD staff. <br /> 6. Applications rec*h►rd after 3:DD pm will be processed the next business day. <br /> t <br /> CONFIRMED APPOINTMENT DATE 'AIME <br /> i7A7E CONFIRMED PHONE FAX INITIALS <br /> i <br />