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0 uA'May.27. 2003 4:21 PM CONDOR EARTH TECH_NCL•3'3 _OGIESCOUNTY 11,Uj 'f ; -hjLP �h�I�V ��) ENV INMENTAL HEALTH DEPARTME: SMEAST WEBER AVENUE, THIRD FLOOR 1 MAY 2 7 2003 ST (20C) 4N -3420CA 2 (20:)468-3420 i NVIRO NMENT HFALTH PUBLIC RECORDS [RELEASE APPLIC;ATICIN 4 APPLICANT fr 1 SUSINESSIAGENCY (20NAoR..>t�A ADDRESS PHONE I 'J,tJ'1 t�.�� O (� FACSIMILI: L{ ` o'izz..�-_-- ._ TENTATIVE' APPOINTMENT DATE a T0)q P aOil3 TIME _�: 41? rn (m �7/3D13 (4i4 (Please Hive T to 10 business days from data of appllratlon sut"Ittal( 1y C HECK BOX YO EXPEDITE REQUEST. $89.00 FEE REQUE(i � T PROCESSED IN 3 BUSINESS DAYS ' 7 q;;: V/ SIGNATURE OF APPLICANT _ [I ATE - ' 0 I ENVIRONMENTAL HEALTH DIVISION FILES UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 13 HOUSING ABATEMENT iO1.JD VI ASTE 7'ACIIRY OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ::OLID Vol ASTE VEHICLE UNDERGROUND TANK (MONITORINGIREMOVAL) (7] DOG KENNEL ❑ HAIRY HAZARDOUS WASTE GENERATOR ❑ CHICK[.N RANCH - ❑ PKG TREATMENT PLANT TIERED PERMITTED FACILITY q MOTEL'HOTEL ❑ I,UIOPEn TRUC"ARWCHEM TOILETS 11 TATTOOIBODY PEIRCING ❑ POOUSPA ❑ LQID U; E APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) 1. List up to ten addresses in the space above. Select the type(s) of filen from the list above by checking the appropriate box(es). At least one file typo! MUST be selected. Fax to 20'F 464.-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed approximately five business days but no later than ten (10) days after rei;etpt of ;Application. The files will be held for a maximum of five business (days for review. Appointments :Thould be scheduled accordingly. 3. A file that Is actively being worked on by EHD staff may not be immedialsiy available for roview. A new application may be submitted when the file Is available. 4. Any file not returned In the same condition wt released will be reorgaroizad toy EHD staff at the expense of the applicant. Future file reviews by the slime applicant may require :I $811.00 deposit prior to review. 5. 'TENTATIVE appointment dates must be con -firmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next busineim day. IM, CONFIRMED APPOINTMENT DATE . DATE CONFIRMED TIME PHONE FAX REVIEWED YES NO REVIEW DATE: INITIALS T r 1\ • • r • Mau -M, �r - LT3,.'�... '1 0 I ENVIRONMENTAL HEALTH DIVISION FILES UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 13 HOUSING ABATEMENT iO1.JD VI ASTE 7'ACIIRY OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ::OLID Vol ASTE VEHICLE UNDERGROUND TANK (MONITORINGIREMOVAL) (7] DOG KENNEL ❑ HAIRY HAZARDOUS WASTE GENERATOR ❑ CHICK[.N RANCH - ❑ PKG TREATMENT PLANT TIERED PERMITTED FACILITY q MOTEL'HOTEL ❑ I,UIOPEn TRUC"ARWCHEM TOILETS 11 TATTOOIBODY PEIRCING ❑ POOUSPA ❑ LQID U; E APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) 1. List up to ten addresses in the space above. Select the type(s) of filen from the list above by checking the appropriate box(es). At least one file typo! MUST be selected. Fax to 20'F 464.-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed approximately five business days but no later than ten (10) days after rei;etpt of ;Application. The files will be held for a maximum of five business (days for review. Appointments :Thould be scheduled accordingly. 3. A file that Is actively being worked on by EHD staff may not be immedialsiy available for roview. A new application may be submitted when the file Is available. 4. Any file not returned In the same condition wt released will be reorgaroizad toy EHD staff at the expense of the applicant. Future file reviews by the slime applicant may require :I $811.00 deposit prior to review. 5. 'TENTATIVE appointment dates must be con -firmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next busineim day. IM, CONFIRMED APPOINTMENT DATE . DATE CONFIRMED TIME PHONE FAX REVIEWED YES NO REVIEW DATE: INITIALS