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'_ �`-�,�� t,•�hrlh �atXuINCOUN�PUBtIGH�A►-�S10N <br /> • <br /> ENVIRONMENTA VELA�,T11\RDFI.oOR <br /> 304 EAST WE.BEA A <br /> siocKSOF1 CAmta <br /> kzq 46a-= <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT av L- 7-2L�A- -- SUSNESSIAGENCY 1' `It p-�a3�^•m-K*'�',-/ "`�'o t'�''Sl^r"�S I ISG, <br /> ADORFss_�•3 l`�. i c t i wry_ "D�- < 100 i (J,b�J4\4'i'o C�4 �l�19 y5 <br /> PHONE 1s2-- �' FACSRAILE <br /> TENTATIVE"APPOINTMENT DATE /2-3o- / I nME <br /> Epte aj eT to 110b--U$jne *days from Oafs of apflo�Uon subniA 1 <br /> CHECK 13OX TO eXPED ME REQUEST•$78.00 Fr,.c7 REOUEST�SED N 9 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ZS <br /> • / FILEADDRE S <br /> 5 <br /> 1'L- ov <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(USTI CLEANUP SITE(LOP) ❑ HOUSING ARATFNFNT d SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON"-OP) ❑ FOOD FACELHY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> " HAZARDOUS WASTE GENERATOR 0CHICKEN RANCH ❑ PKG TR.JITMENT PLANT <br /> Q TIERED PERMITTED FACILITY ❑ MOTE LMOTEL ❑ PUMPER TRUCKf1 ARDICNEM TOILETS <br /> ❑ TATTOOSODY PEIRCING ❑ POOL)SPA ❑ LAUD USE APPLICA-00N SITES <br /> 0 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHE P.(PLEASE SPECIFY AD OVE) <br /> 1. List up to ten addresses in the space above. Select the type(s) of filen from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to f209) 464-0138 or mail to the <br /> vddre s indicated above. <br /> 2, EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed <br /> approximately five business days but nc tater than ten(10)days afber 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 immediately available for review. Anew <br /> application may he submitted when the file Is available. <br /> 4. Any file net returned in the same rendition as released%III be reorganized by EHD staff at the expense <br /> of the applicant- Future file reviews by the Same applicant may require a$78.60 deposit prior to review. <br /> 5. 'TENTATIVE appointment dafes most he confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> x <br /> arsau AVL CG1,t✓"I�Tc A / 1 TOTAL P.22 <br />