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v onr6t Avco SAN JO IN COUN-'YPUBLIC HEALTH SFJ- -'CF--S <br /> F-MIRONMENTAL HEALTH DIVISION �d <br /> >G� 306 EAST WEBER AVENUE,THIRD FLOOR <br /> $TOCKTON GA 95h02 <br /> (209)4583420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT <br /> ADDRESS �'� ��C'�'{f��7�s'r�yr •c/ .P� r'rl/7 L�`.� /.E� i� � �x� <br /> TENTATIVE"APPowTmENT DATE TIME <br /> (Please tlivo 7 to 10 bus:rK�s daysfT datc of appiicAIJon sudmivaq <br /> C,IIU�fiS �'� , <br /> ED " <br /> CHECK E10X TO EXPE01TE REQUEST,S70-OO FEE--ItEOUEST PROCESSED W 3 13USINES'S DAYS ZOO <br /> 1 1 <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> n11I Ir"irjFff nn Lit <br /> r- No 1111-11111 <br /> C ~ <br /> * --?I <br /> ENVIRONMENTAL HEALTH DIVISION FILES OC T 2 2 ol <br /> UNDERGROUND TAW(UST)CLVANUP SITE(LOP) O HOUSING ABATEMENT �50iID WASTE FAUU rY <br /> OTHEH CLEANUP SffE(NON-GOP) Q FOOD FACILITY SOLID WA5TE VEHICLE <br /> UNDERGROUND TANK(M06[ITOVJNG5W A0VAL) O OOG KENNEL O DAIRY <br /> HAZARDOUS WASTU GENERATOR ❑ CHICKEN RANCH PKG TREAT"E PLANT <br /> L7 TA=PED PERMITTED FACP-" ❑ M43TELMOTEI PUIdPER-T UCWYAItUtiH�M TOILETS <br /> C] TAT-1700W4DY PEIkCING d POOL/SPA LAND USE APYUCAT70N S[TES <br /> KMGDICAL WASTE FACIUTY ❑ PUBIC WATER SYSTEM OTHER(PIJEASE SYECiFY AEIOYE) <br /> 1. List up to torr addret;--es in ilia space above. Select the type(s) of files fro Ist a bcl�eckirlg <br /> the appropriate box("). At least one file type MUST be seleeted- Fax t (?49 464-0938 or imAil tot e <br /> 4ddress Indicated above <br /> 2. EHO will notify the applicant if any EHD files exist. An appointment for reyiew w111 be confirmed <br /> approximately five business clays,but no later than ten(10)days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3_ A file that is actively being worked on by EHD staff may not be immodiatoly available for review. A new <br /> application may be submitted when the file is available_ <br /> 4. Any,flle not returned in the same condition as released will ba reorganized by EHD Mff at the expense <br /> of the applicant- Future file reviews by the same applicant may require a b711_00 deposit prior to review. <br /> 5. 'TENTATIVE appointMent slates must be confIrMerd with EHD staff. <br /> 6_ Applications received after 3.00 prn will lie processed the next business day. <br /> i CONFIRME-0 APPOINTMENT DATE TIME --- 1 <br /> DATE CONFIRMED PHONE FAX INMALS <br /> ` REVIEWED YES NO REVIEW DATE <br /> E+ ou i. a vvsrpc <br /> - �— <br /> turas P.(iL <br />