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A�6A,�.,���QUIN COUNTYPUSLIC HEALTH SE /CESNVIRONMENT <br /> APR 0 7 200 4 EAST W BER AVENUE,THIRD FLOOL HEALTH R <br /> S70209)4N CA20 ,�a30 <br /> ENVIRONME (zDg)a6e-naso <br /> R llb�RECORDS RELEASE APPLICATION <br /> APPUCAHT�S�Ey\...L,>r _auswessi/A�aeNCY Lt�'S .�r�prw>Lio%t <br /> �, ADDRF:S—_ tL d 5�``. 2i5b 19ANAt ,l t,¢ <br /> HONE U0 Thr' <br /> a <br /> TENTATIVE'APF0INTMEHT DATE 4" A e s o 5d4 e TIME �rw�.(,,,, dc• �ne f ur lrrsi�vss <br /> (PI""alve 7 to 10 huslnoee dRye lam evt!of appIcaeon <br /> -tVW/,//eke/o 4-WF Ile,•d�C <br /> CHECK DOx YO ExxDTtG REQUEST-111 <br /> %89.00 FEE-RfiOUESTPROCE55EO 1N 3 eUSWESa DAYS ymt <br /> +,SIGNATURE 01=APPLICANT /.,olr...7 (�/� DATE <br /> IAMB <br /> Fu,J;,tpDREg3SSID sE nl ' <br /> PROGRAM fiLEMENT&SEARCH <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> O UNDERGROUND TANK NSTI CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT O SOLID WASTE FACILrrY <br /> 0 OTHER CLEANUP SITE(HCNICP) 0 FOOD FACILITY E3 SOLID WASTE VEHICLE <br /> • UNDERGROUND TANK(MCwrrLRINGIRENOVAL) O DOG KENNEL 0 DAIRY <br /> 0 HAZARDOUS VIA=GEWFIATJR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> O TIE t9D PERMITTED FACILITY 0 MOTLLIHOTEL 0 PULIP£RTIZUCK/YARDICHEN TOILETS <br /> ❑ TAT7001BODY PGIRCING 0 POOUSPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTEFACLLJTY CJ O OTHER(PLfiASE SPECIFY MOVE) <br /> 1. hist Lip to ten addre,ssos In the space above. Select the typos)of files from the list above by checking <br /> the appropriate GNA:(ea:). At least one file type MUST be sNoetad. Fan tO(208)4§4-0138 or mall to tha <br /> addroag'I Ica !SL}'bave. <br /> 2. EHD wiL;notify the.applicant If any EMD ill es exist. An appointment for review will be confirmed <br /> approximately itte business days but no later than ten(10)days after receipt Of appllution. The files <br /> will be held fora maximum of five business days for review. Appointments should he scheduled <br /> eccoedingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the foe is available. <br /> 4. Any fila not ratumod in the same condition as rolassad will be reorganized by EHD staff at the expanse. <br /> of the applicant Futuro file rvvlows by the same applicant may require,a$89.00 deposit prior to review. <br /> 5. 'TENTATIVE apaointment dates must be confirmed with EHD staff. <br /> E. ApplIcations rgceived eller$:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME {� <br /> ! DATE CONFIRMED � PHONE FAX INITIALS <br /> REVIEWED YES NO PAIAEW DATE <br /> aos.brm <br /> £d WUSO:0i :700Z L0 'ad,d 'ON Xtid W02id <br />