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[-eh 09 11 Obi IC"l Anna 2004814633 P1 <br /> 02/02/2011 09:02 20`: )13 E. ENVIRONYENTAL -TH PAGE 02/62 <br /> DATE RECEIVED EHp LOG NUMBER�IaAQUIN COUNTY <br /> c , ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, GA 95202-3029 C1 1 <br /> �E6 2�i�,. Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.orlglehd i <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> TAL 1 u 1 �} <br /> [,N\11 ElIGEf A t CVZ8 O � 0� BUSINESSIAGENCY: <br /> ADDRESS: r,, Q,p 3 -tr CFTYISTATE/z(P: L a J. 9 <br /> PHONE (11j: a S `� 3 S o`a PHONE(2): FACSIMILE: '�U o t-0d_ -7 <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 tuwsiness'days dato of lication sub mittal tFft only-must be confirmed) <br /> [�CHECK BOX TO EXPEDITE REOJE 22 P H REOURST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT t DATE --) — oi - <br /> Electronic Information: [] List❑Map-Description: <br /> FILE ADDRESS END USE ONLY <br /> Street# sweet Name Caty (Q <br /> Unit 1 <br /> r2. <br /> ❑Unit 2 <br /> Utlit 3 <br /> Unit ti <br /> 6. <br /> 7. ! <br /> S. <br /> 9. <br /> tl. <br /> Untt 6 <br /> Specific Date Range of information Requested: From (=U 1 lc=l t--(r to / <br /> ENV[RONMENTAI HFALtkI DEPARTMENT FII ES <br /> V DERGROUND TANK(U ST)CUEANUP SITE(LOP) H HDU"SWG ABATEW'-NT ff otw Wash:FACT mIVEHtCLE f <br /> Ly OT"ER CLEANUP SITE(NoN-LOP) Foot)FAciury ❑WAM 71RE <br /> 015�VNDBMGROND TANK(L1IO ORINWR6M0VAL)v( ❑DOO KENNM ❑DAIRY eA AWDOUS WASTEGENERATOR ❑CHICKENRANCH ElWA5't E7A rm TREATMENTPLANTTrE,REo P>�m7n-m FACILI11 \ Lj IV10-tEL OTM 0 PUMPER TRUCK/YAWCHEMALTOILE '`� <br /> ElTATTcWEIoDY PIERCING u1 PDOUJSPA ❑LAN USE APPLICATION WES <br /> ❑ MEDICAE WASTE FACILITY ❑OTHER(PLEASEb`M" <br /> WELL AW SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW, MONDAY-FRIDAY 8.00 Aht-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. Wst qe to ten addresses in the apace above. Select the typ (s)of files from the list above by checking the appropriate <br /> box(as). At least ono filo typo MUST be selected. Fax to2(_091464-0188 or moil too th9 address indicated above Address <br /> ranges will not be accepted-for additional assislance with file addlomos,contact the END. Applicatirms recelyed aNr <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant If any EH0 files exist An appointment for review will be confirmed approximately ten(10) <br /> days after recaipt of application. She files will be held for a maximum of five business daps for review. Appointments <br /> should be scheduled accordingly. <br /> 3. Afile that is sctivoly being worked on by EHD staff may riot be Immediately available for review. Anew appiloation maybe <br /> submitted when the file Is mmilable. <br /> 4. Any file not mtumed in the same condition as released will be reorganlzod by FHD staff at the expense of the applicant. <br /> Future file reviews by Me same applicant may require a$122 daposit prior to review. <br /> END iISE ONLY <br /> Um U-46 <br /> QTr29r10 <br />