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if 09/16/2003 15: 53 929371;`5915 GEOCON - EAST PAY PAGE 01/1 <br /> ENVIRONMF-N �, AL TH <br /> PAGE 02 # <br /> I DATE I2ECENED � SAN e1�QA. U� CUY �n� PAGE_ <br /> � ��; Y, D1 Errvz�ortzrx�zvxax.MALTH D pA tTM ' <br /> . .304-E Weber Ave 3'4 Floor Stotktoli, GA 95205 <br /> SEP 1 6 2001209).46$-3420 Fax. (209).464-013$ Web:www.co.=-joaqi�in.ca'.-as/chd <br /> ENVIRONMENT HEALTH YUSIX RECORDS RELEASE APPLWA'ITiON ' <br /> P 11/771 <br /> APPLICANT. LL susimEssiAseNcy: (fO <br /> j20� <br /> ADDRESS: <br /> PHONE:�z 7t'' L d_ �. �TFACsnNILS• Z <br /> - I <br /> TENTATIVE•APPOWTMENT DATE: -Pme; i <br />! (Pleaae allow 10 dVmineaa d"from dote of appligatlan suwlttaq <br /> CHECK BOX TO EXPVDITE BEQUEST•$93.00 PEE-REOL) PROG):SS D 43 DESS DAYS <br /> SIGNATURE dF APPLICANT DATE C� <br /> 0602 ent Us*Only <br /> ILE ADDRESS UW <br /> I <br /> W, 3 C aUnit 1 <br /> C aA4 L 52 <br /> , I <br /> a a � O e rs c <br /> le c [/ 113 <br /> z o . s <br /> ec ch! <br /> Unit 4 <br /> z e a <br /> 1 H r ❑ Unit 5 <br /> to. <br /> ENVIRONMENTAL HeALTH DI~PARTMENT FILE$ <br /> Uric eRGPOUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT 0 SOLID WASTE FACILrry <br /> V OTHER CLEMUP SITZ,(NOWLOP) r. FOOD FACILITY Q SOLID WASTrz VEHICLE <br /> Q UNDERGROUND TANK(MONITORINGlREMOVAL) ❑ DOG KENNEL d FAIRY <br /> Q HAZARDOUS WASTE GENERATOR C1 CHICKEN RANCH O PKG TREATMENT PLANT <br /> CI TIERED PERMITTED FACILITY 4 MOTSLIHOTEL CI PUMPER TRUCKrYARD1CHEM TOILETS <br /> C TATTOW1300Y PiEPtCING Q POOLIBPA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY d OTHER(PLRASR SPECIM <br /> 1. hist tap to ten addresses in the space gbave. Select the type(s)of files from the Ifat above by checking. j <br /> the appropriate box(es). At least one file type MUST be selectod. t=ax to (JOR14%-0128 gr Mail tom <br /> gdgres5 indicated a§ay <br /> 2. EHO will notify the applicant if any EHO files exhSL.An appointment for review will be confirmed <br /> apprpxlrnately five business days but no later then ten(10) days After receipt of application. The flies <br /> will be held for a maximum of five business days for-review. Appointments should be scheduled <br /> accordingly. _ <br /> 8. Afile that Is actively being worked an by EHD staff may not be immediately gvaglable far review. A new <br /> appllcaticn may be submitted when the File is a'valtabte. ' <br /> a. Any file not returned In the game condition as released will.be reorganized by FMD staffat the expense i <br /> of the appilcAnt. Future file reviews by the same applicant may require La$93.00 dappslt prior to review. <br /> S.- 'TENTATIVE appalritment dates must be confirmed with EHO staff, <br /> G. Applications recalved after 3:00 pm will be processed the next bualnaas day. <br /> i <br /> CONFIRMED APPOINTMENT DATE �, _ - TIME <br /> PATE CONFIRMED PHONE . FAX INITIALS' <br /> REVIEWED YES No REVIEW DAT(; <br /> "Mai <br /> Il <br />