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06/28/2005 11:46 FAX 770 642 0257 RMT INC. ATLANTA Ld.]002/002 <br /> 06/24/[220055 07:50 464013, ENVIRONMENTAL HE. -,-H PAGE 01 <br /> AN <br /> Ml Liu �l ® ENVIRONMMMNTAOLAHEEALTH COUNTY <br /> DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA, 95202-2708 <br /> juA 2 00 7005 Telephone: (209)468-3420 Fax: (209)4644138 Web:wwwsjgov.org/ebd <br /> Elip{isppplsp�jf pq' T HEALTH. <br /> . PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCANT: uSdmc Mow SUSINMSIAGENCY:RLVLT� I h c. <br /> ADDRESS: 1 (w R019aI-s Drive-, s�kite loo A4w1 ,�, GA 3o350 <br /> X4 PHONE(1): �L(P-A L 2 5G Y'149 PHONE(Z). FACS(WLE: _j1 O-&42-OZ 51 <br /> TENTATIVE`APPOINTMENT DATE:_ 11121D5 TOQ AM <br /> (Pleaso allow 10 business days from date of application submltUl-'Teafa6e only-must he confinfled) <br /> b�' © CHECK BOX TO EXPEDITE REOURST 423.00 FEE( H OR CHECK ONLY)—ItMMT PROCESSED IN 3 BUStNESS DAYS <br /> SIGNATURE OF APPI..ICANT - DATE (P12 iaID 5 <br /> 0111M Ole <br /> UNIT oiSTRI6tlTION II UnK 1 U WJ 2 b WCM 4 0 Unit S Unit B p Other(elacLunI UsWmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street Street Name City rA`__ <br /> �. 15 esfi t c <br /> 3- :Z i S S .'n�Ic !� H v 2 p(. I Cf 1 L <br /> 4. _ <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> 'Specific Date Range of Infomtation Requested:From -- -- 1C)l b to 005 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> URDERMOUND TANK(UST)CLEANUP tM(LM) ❑ HOUWRG,ABATEMENT ❑6ouD WASTE FAAUTYN <br /> ORI£R CLEANIH'SITE(NoN-LOP) a Fom FAratm ❑WASTE TIRE <br /> �(UNOEROROUNDTANK(MWT0RINGIRC1A0YAL) O DOG KENUM r7 DAJKY <br /> HAZARDOUS WASTE GENERATOR 13 CHrW_N pwch ❑WAsTEWATERTREATNENT PLANT <br /> O TMED Pou=Tm FAcu w ❑AAota.A om O PUMPER Tttucn/YAAD1CItE3d TOILETS <br /> ❑TATTOOIBODY PERCata 0 POOLISPA d LAM USE APPLICAPON SITE& <br /> ❑MEMAL WASTE FACILM 0 011MR(PLEAF,E <br /> WELL Arra SMM PERT RECORDS ARE AVAM9LE FOR REVMM- MOWIAY-FMAY S 00 AM-6:0 ' Exch MLIDAYs. <br /> 1. List up to ton addresses In the apace above. Select the toe(s)of files from the list above by checking lila <br /> appropriate box(Os). At least one file type MUST be seletted. Fax to(209)4 38 or mail to e--add ME!; <br /> indicated above. Address ranges will not be accepted—for additional assistanco with Tile addresses,contact <br /> the END.ApprcaUons received after 3,00 pm will be processed the next business day, <br /> 2. The EHD will notify the applicant If any EHD files exist, An appointment for review will be confirmed <br /> approximately ten(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 avdilable for review. A new <br /> application may be submitted when the file is avallable, <br /> 4. Any file not returned In the same condition as released wilt be reortianizta <br /> ed by EHD staff at the expense of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 depostt prior to review, <br /> V. <br /> 1 <br /> �o as-aZ-0oe <br /> 1 tl1-tNJ , <br />