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kf-�'!-dOwl 34V 12M9 1- LIN %Mole Ju <br /> SAM JOAkMN COUNTYPUBLIC HEALTH SERVICES - r <br /> E= VIRONMENTAL, HEALTH DIVISION <br /> 3114 EAST WEBER AVENUE,THIRD FLOOR <br /> t21Xya-U2�2oz MAY 7 2001 <br /> PU13UC:RECORDS RELEASE APPLICA'nON <br /> �APi'LSCAlDT 1 CFIAa,y Fisc w"A'= SUSINEWAGENCY <br /> f'ADDREs5 203-718 oe'xs emp,,.x �i.vcii &,.rlm1oo ._..,,... .. .//. <br /> '-Px�tE {AZ '5-!3� y , 'Z <br /> _ FACSUWLE,, E %3 it 7`44 <br /> TENTATIVE"APPourrw+r=rrr o�-mFSA P _ nn - 1 b �'� <br /> (Picas*ytvs r to ea ausww"daystrwn dato a1 aRR6G+iion wxnival) <br /> CHECK BOX TO EXPEDITE RF-QUEST'-4T.99 FU-AMVEST PROCESSED 1K 3 BUSINESS DAYS <br /> 14sir. A-rU* RIE OF APFUVANTI DATE S f <br /> z Lf Zoe <br /> FSLF ADRRF.SSHD�� THFS SIDS zKv s7APF USE ONLY <br /> F-xCA4�'—A2: 1-1.4lfilFCA PROGRAM ELEPA0474 V-ACH <br /> ANX.t E od�,+.,� ,4,w,-ra.. ""'3S••1� �c - -- <br /> ct+s+�ry �9->!a� 12a7 1 �t�77rs - 3s•�4 � - . .. - -- - - <br /> 1 --- <br /> r-�z <br /> i�rNo As lvoi ' XW4lv7,r* 5v 3S �7 Jtu <br /> uNea rf 5M0 -XV IIQAEq,M 9,/0- KA-- <br /> ARCO <br /> A-,-AGe 40r40 171 }'ssEI�i-E Z C,a. W v'3.5-a R anti X35.1'7 r - <br /> CAL 772A+r l -Dx. roP-v $ vi.44. CoRf`�CrE u3S ;,7 LD <br /> SPi4�errsLs SvdrrR ro ! •, +.&� .29•s`v <br /> VriIM-,> AARx rFX)c;-x 3o f e,r 7tsmee- i J- � <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> qUD RGii 1N6 TANK(UST)CLEANUP SITE NOP) ❑ K1)U iNG AGATEME'ur O SOLID WASTE FACILITY <br /> O QT}iER GtFAD1UA SITE(PtOhL�Dt') a FOOD FACliM © a0L10 nrASTE YfM CLE <br /> Q ;UNDERGROUND TANK(MONfT IWIG1REMOVAL) 0 DOG KF.M0. 0 DAIJ%Y <br /> P 'HAZARDOUS WASTE GENERATOR 17 CMGKEN tiANDtt 0 MG TREATMEtCrPLAKT <br /> C3 MEED PERMn-MD FACiL{TY ❑ MOTEUHpTEL PUMPCCR TJWCKrYAF"UHE4r 70tLM <br /> D3 ;TATtMHODY PEIRS`i i$ t7 POcuspA Q OUSE APPLICATION Sr= <br /> D 'MEDICAL WA$TE FACAUTY ❑ Yt)SUC WATER SYS"FA QTHXR( M"P-SnQFYABOVE) <br /> 1. List up to Ign addresses les' ho space above. $elect the typets)at fil@.from Me list above by checking <br /> the appmprigtte box(es). At)east one file type MUST be selected. Fax o JZRM 484-0136 W_r1lai�t�ll�Q <br /> 2. - Fi w;'4111 notify the appl(caeyt if any EAD files exist. An appointment for ruvieW vdti be confirmed <br /> appm-91mateiy five btlsines' days but rto later thein ten(10)days after receipt of appiira Uon. The files <br /> wiif bO hold for A maAmum"of five business days for review. Appointments shoUlcl he scheduled <br /> acoorttilzgty. . <br /> 3. A III*that is actively beim$ nrCAaa on by flab staff May out be immediately available fvr review. A new <br /> a pplic;wdon may be subz itw omen U20 file is awaills wc. <br /> 4. Any fltd not returned In the »*Oondltlon as r>ofeased w!4 tis reorgans"d by EM staff at tft*xpense <br /> Of the applicant, Future filq ravivws by tho same aPP00i1rA&wy rstluire a U7.09 deposit prior to Ievisw. <br /> 5. 'MNTATIVE appointment dates must be confirmed verth END staff. <br /> ra. Applications received a1Wr.:3;Q0 prn will b7a processed the next business day. <br /> i . <br /> CONFIRMED AP?blNTM6rIT DATE <br /> PAYE CONFIRMED _ PHONE FAX INITIALS <br /> i <br /> REVIEWED YES NO REVIEW DATE <br /> MTRL P.01 <br />