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06/27/2006 ]0:53 FAX :– �4 X002 <br /> s <br /> EHD LOO NUMBER <br /> RATE RECEi 4 SAJN JOAQUIN COUNTY�� <br /> ENvtRo mENTAL HEALTH DEPARTMENT <br /> 304 East Weer Avenue,3r°Floor, Stockton,GA 95202--2705 <br /> Telephone:(204)465.3420 Fax:(204)454-0138 Web: %1WW.sJBov.orr,lehd <br /> r i <br /> �r PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> L� 4 BUSINF_SSIAGEN�CY: �I�1 .. � woe-. <br /> ADDRESS.' IiO <br /> PHONE(1): PHONE(2): FRGSII441LE: � <br /> TENTATIVE`APPOINTMENT DATE: <br /> t (Phase allow 10 business days from dale of application submittal 'Tei*Om only-mint tre coe-inrad) <br /> r 1# } <br /> © CHECK SOX TO EXPEDITER U -$93.00 ( R HECK ONLY)•REQUEST PROCE3SF-1?IN 3 BIJSINES DAYS <br /> SIGNATURE OF APPLICANT DATE `L' b <br /> UNITD1STMUFIAN O Unit UnE 0 UnK3 r3.Unit4 O UnKS 1�0 Unitt 13 Othar(clectronIdIbrI Imaps) <br /> FILE ADDRESS _. " EHD USE ONLY � <br /> c <br /> Street' '^ _ c <br /> Streer Name _._. _ <br /> 2. <br /> a. 141T. �kMklMM+ � — V !L <br /> 40M y <br /> � . <br /> Specific Daae flange of Information Requested.From '; to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ij UNDERGROMO TANK(USTI CLEANUP SITE(LOP) 0 HOUJSING ABATEMENT 0 SDUQ WASTE FAUU)'IYA(MCLE <br /> OMFR CLF-ANLIP&M(NON-LOP) Q FOOD FACILTIY ❑WA5M TIRE <br /> UWvK0K*MvTANK(NoNiToiNaIREMOYAL) Ci Doe KFNNEL ID OW" <br /> HA7Armous wAam aeNfeRATDR Q MrrrcAM RANCH ❑WASTEWATER TAaAnWkIT PLANT <br /> )C3 TIERm PERmn7ED FAC1UTr ❑MoTaLIHOTEL ❑PumptsR TRUC10YAti171CHW TOILETS <br /> G]TAITOO113ODY PIER,4ING ❑POOL/SFA ❑LJ w un APRUcAncw SITES <br /> E3 MEDICAL WASTE FACiUTY ❑0ni1ER(kAASES <br /> WELL AND SEPTIC PEWIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-Ffnmy 8:44 A*6:44Pra - EXCLUDING HC4.I00S. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from'the list above by checking the <br /> appropriate box(es). At least one file Hype[DUST be selected. Fax to i(209)4:6"138 or mail to the address <br /> Indicated above. Address ranges will not be acts F <br /> >� accepted–for addltlon�(a-�I�tance with Elle addresses,cc�ntaot <br /> the EHD►.Applications received after 3:00 pm will be processed the next busirims day. <br /> 2. The EHD will notify the applicant If any EHD files exist. An appolntsrient for review will be confirmed <br /> approxinniWly torr(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> appllcatlorl may be submitted when the file is available. . <br /> 4. Any file not returned In the same condition as released will be morgan¢ed by EHD staff at the expense of the <br /> applicant Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 1I1di06 <br /> i <br /> 1 <br />