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Aua-29-07 16:48 From-BROWN AND V-71.1 16 635 8805 T-869 P.00V002 F-048 <br /> AN JOAQ�N UNTY <br /> Y EHD LOG HUMBER <br /> 9 ZU07 ENVTRONMENTAL HEALT DEPARTMENT <br /> 600 East Main Street, Stockton, GA 95202-302 <br /> HEPl lephone: (209)468-3420 Fax. (209)464-0 38 Web- www.sjgo r ! d <br /> PUBLIC RECORDS RELEASE APPLICATION ll L +�- <br /> APPLICANT: 8U81NESS/AGENCY: WN GAL I nVEL <br /> Al)DM3S_ M64o lrl.,�n,ae G�- t11`� � D TR-0 caluiVk CA q5vlo <br /> PHONE(1): I "3" :�J PHONE(,2)r: q10 1 '^ L FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: tip Time. oDoth'1 <br /> (Please allow 10 twsfness days from date of afklicatihn subm tial-'Tentative only-must be confirmed) <br /> © CHECK BOX TO EXPEDITER QUEST-$8$-00 FFE(CASH OR CHECK NLY)-RE=QUEST PROCESSED IN 3 13USINESS DAYS <br /> SIGNATURE OF APPLICAN DATE f <br /> Electronic Information: ❑ List❑Map—Description: ; <br /> FILE ADDRESS EHD USE ONLY _ <br /> Street# Street Name City . ❑ Unit 1 <br /> I <br /> 2. W Unit2 <br /> 4. (� Y" - 4+t � �/ Unit a <br /> // c� k €aUllt�a Y, <br /> ❑ Unit 9 <br /> �b 1 N. ,r L11 unite <br /> 10. <br /> Specific Date Range of Information Requested:Frpm I� to f <br /> ENVIRONMENTAL HEALTH DF-P RTMENT FILES — <br /> J2'UNDERPROUND TANK(UST)CLEANUP SITE(LOP) HOusma A6ATEMENT C3 SOLID WASTE FACILITY[VEHICLE <br /> 2rOTHEP CLEANUP 8(tr(NI)N-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ErUNDERGROUNE)TANK(MONITORING/REMOVAL) DOG ICENNSL ❑ DAIRY <br /> 17HAzARDOUS WASTE GENERATOR IM GHICKeN RANCH a WASTEWATER TREATMENT PLANT <br /> E3 TIERED PERMITTED FACILrrY ❑MoTEUNCIrEL ❑PumPERTRUCK JYARD/CHEM TOILETS <br /> 17 TATTOoi13DDY PIERCING ❑P00USPA G?UND USE APPLICATION SMZ <br /> ❑MEDICAL WASTE FACILITY IO OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT FtECORA;ARE AVAILABLE FOR REVIEW -MONDAY-FRIDAY$_00 AM4,00PM -EXCLUDING HOLIDAYS. <br /> t. List up to tan addresses In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 249 4!W-0131 or mail to the address indicated above_ Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHD.Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointme t for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3_ A file that is actively being worked on by EHD staff may not be immedli Itely <br /> available for review. A new application may be <br /> Submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorgani zed by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHb USE ONLY <br /> CHD48-06 WEB M12007 <br />