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To:Diane Martinez Page 1 of 1 2010-02-17 05:29:25(GMT) 15103720452 From:Tim Loeb <br /> EHD LOG NUMBER <br /> UD- <br /> SAN J(3AQUIN OOUNTY <br /> FEB. 1 7 201Q ENWIRQNMENTAL HEALtH DEPARTMENT <br /> BO(}East Main`St. Stockton, GA 95202 3429 <br /> ENUfR7 l�1ENT HE .ff*lephone (209)46 P3420 Fax: {209)464-01381f4►eb vwuw sjgov_or <br /> PERMIT/SERVIC.8-S PUBLIC REC©RDS RELE/�t.SE APPLICATION <br /> APPLICANT l/ t O G4 to `,O BUSINESS/AGENCY TiN L- <br /> ADC1Ri=SS` $ 'CITY/STATF kio ��+t/ <br /> PHONE(1)-t� dr35 � Q PHONE`Zj. AcsiMILEsro .� �`t45z <br /> 77 <br /> 77. <br /> TENTATIVE*AP.POINTIuIENT DATE Time <br /> (Please allow.,10 1064kyo dato of app4{cation submittal "Tentatrve only=must be confirmed) <br /> Q CHECK BOX TO EXPEDITE RE EST X11 EE(CASH C CK ONLY}-REQUEST'PROCESSED IN 3 6USttVESS C3AY$ <br /> SIGNATURE OF APPLICANT ' e,B . QA CE � a f a <br /> Electronic informs#ion: : List[Q Map-Descrip#ion: <br /> FILE'ADDRPS5 D UsE ONLY <br /> EN <br /> Street i Street Name:; Cify ©'Urtlt 1 <br /> Z <br /> ❑Unit 2 <br /> 3... — - <br /> 4. <br /> ` n03 <br /> Ur <br /> l3, �.Unit 5 U <br /> p Unit 6 <br /> Specific Date Range of lrrforrnaton'Requested From, to <br /> ENYlRONttlfENTAL HEARTH DEP..ARTMENT FILES; <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) �,HOU$ING`ABATFautENT []SOLID WASTE,FACILITY/Z/ERICLE <br /> 07HER CLEANUP SITE(NON-LOP} Q;FaoD FACILITY Q WASTE TIRE_. <br /> '�UNDERGROUNR TANK{MONRORING/REMOVAL} ❑DOG KENNEL ❑DAIRY <br /> " IfAZARDOUS WASTE GENERATOR ©CHICKEN RANCH [�WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY [l MOTEL/H TEL ❑PUMPER TRUCK/YARD/C0EMICAI TpILETS <br /> ❑TAT700BURY PIERCING [�;POOUSPA' ❑LAND USE APPUCATtON,SiTES <br /> Q MEDICAL WASTE FACILITY ❑QTFIER.{PLEASE SPECIFY) <br /> WELL AND SEPTIC PERIfAIT RECORDS ARE AVAltA9LE FOR REVIEW: MONDAY F WPU(EXCLUDING F{aL(DAYS) <br /> List urs to>�en addresses ri the space above Select the types}of files frgm the fist shave by=atiecicirg the appropriate <br /> box(es) At least one fife"type MUST be selected:Fax to(2o914fi4 U138 or mail to the addiess indicated abave.-Address <br /> ranges, riot be accepted fof add tlonal assistance with file addresses,contact the EHD.yApp(icatl"ons feceived after <br /> 3-00 pm will be processed the next business tlay <br /> 2 The EHD tinnll notify the applicant if any EHD fifes eaast An;appolntment far revsew viol#Ise confirmed,approximately tcn(t 0} <br /> hays after receipt of application ,7he 51es wfil be.ietd for a maximum of five business d4ys for review Appointments <br /> should# scheduled accordlrtgly <br /> 3. A fits that is actively being woricet on by EFlD.staff niy not be ROM ediateiy`availabtefar revievV A new application may be <br /> submitted when#tie file Is avarlabte ` <br /> 4..'Any file not returned in the same,conditton as released wilt be reorganized by EHD staff at th expense of the applicant <br /> Future file reviews by tkre earns applrcanit may rettuire a$115 deposit prior fo review. <br /> Ci. tf you need further assistance,please,caritact Diane Marttnez at(2Q8)46&3425 <br /> 7777777777777777 <br /> EHP.113E dNt,Y.::� <br /> EHD48 A6 8/27108 <br />