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Fab-11-2002 04:37pm From-K1NKO'S SUNDRO • 15103578053 fry{ =4 y'p 2qq�., -1 . <br /> OUN7YPUBUC HEALTH SERV)q � �� T.. <br /> r} PAENTAL H A)..TH DIVISION <br /> a W1rBEm AVENDt~,THIRD FLOOk <br /> STOCKTON GA 95202 <br /> (209)468-3420 74 oel <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 140C OUSiNESSfPdGENQY +rte (/lrs.y �•/{ % <br /> Abt}REs$ �'! _4�-_ 1ad'� r.-.�P ..r rr ter+ — -- - -— <br /> PHONE <br /> (f-5 4(10 <br /> b. <br /> — TENTATIVE*APMNTll ENT PATE OF. <br /> �vbinlmn <br /> WRMEU <br /> date <br /> il <br /> CHECK BOX TO EXPEDITE REQUEST: 2.4 0 F&F £ N 8�r51iVSg I]AifS ! <br /> Ile <br /> SIGNATURE OF APPLICANT iGrP � DATE <br /> >r7R:E ADD SS :i THIS SIDE EHO AF'FWEONLY <br /> PROGRAM ELEMEN=9EAP.Ctf <br /> /4 IYZ!Ez 3S• <br /> • .i <br /> I <br /> ENVIRONMENTAL HEALTH DIVISION FIL i 5 <br /> N UNDERGROUND TANK'(UST)CLEANUP SITE(1-66 0 HOUSING A3A7EA11EKr CI SOLID WASTE FACI1.1TY <br /> © OTHER MUP SrTE(NQN-LOP) ❑ FOOD FACILITY C7 3MM WASTEr VEE CLE <br /> 0 UNDERrPROUND TANK(1 AQ?4jTQRINGrK9MUUAL) M OW KE14NEL Q DAIRY <br /> Q MAZAPMOUS WA4I4 GENERATOR a CHICKEK RANGH It P=TREATMEMT PLANT <br /> R •TIERM PER)1 rjwx FACiLrry I' 13 MOTELIMOrML a PUMPE13 TRLCK1YARWC4 iF.M TOILETS <br /> ❑ TAT OWBODY FaRC1NG 13 PGOUSPA 6 LAND 135E APPLICATION SITES <br /> 0 UZ-0IGAL WASTE PAC Lf Y ❑ PUBLIC WATER SYSTEM Cl OTHER(PLEASE bPECWY AROM <br /> 1. List up bra tori addresses in the space above. Select the type(s)of files from the list above by cMecking <br /> the appropriate box(cx). At least ons file typo MWTbe selecte& Fax to(es)Ai-p138 or radii m 1�e <br /> paclress indicated ahgnfe, " <br /> I 2. P-HD will notify the applicant If arsy Ehf)files exist'- An appointment for ravi4rw will be wafirmed <br /> appra idmataly five b ainess days but no later than ton(10)days after mceilat of application. The files <br /> will by held for a maxlmllurl of five business days for review. Appointments should be scheduled <br /> 1 accordingly. <br /> I A file that Jr.Roveiy being worked an by EHD sxaff may not be immediately available for review" A new <br /> ' eppiICation Maybe SLIbm fed when floe Me is avaAabie. F <br /> 4. Any file riot rete med In the carne condition as released will be reorganized by EHO staff at the expense <br /> of the app(icanL Future file rmviwwa by the name applicant may regeaIm 4$8940 depoail prior to ravlow. <br /> 5. 'TENTA7WF-a#ipvintmont nates must be confirmed with EHO staff, <br /> 1 G. Applications received air 5:00 pm will be processed the next busim e$s day. <br /> CONN;IRMED AprojwMl=err oArE T04E <br /> DATE;CONFIRMED PHONE FAX IHfi7ALS <br /> R VI£`1M�o YkS NO ,. REVIEW DATF , <br /> I <br />