Laserfiche WebLink
2&J 422:8 P67-. <br /> FROM NC-q Ener irc-nmental <br /> SATti JoAQUiN G0IjNTyPUIa6C HEALTti SF_RVICF.5 <br /> ENVIRCINMEWAt_M4LTM DIVISION <br /> 304 FAST VnMER AVENUE.THRO RD= <br /> =DCKT=dD.us= <br /> Ptl BUC RECORDS RELAABE APPUCATION <br /> -D US ---0�,J I-A-ta E <br /> =Mmawm4ambrr I L 0 aiv-:t�o t,-' A�6-soc <br /> N 14 1 L—C)C-5.-j 1 Cdqr <br /> 2 3t p 61 — +2. <br /> WM 'Z5 <br /> TEWATIVE1 ApFoEnr"t re,Ila W 200 <br /> 5�-- -z-�� 11-_-S L -f n.- <br /> onmaza arwa T 10 113 tftakft"days nom cab't 2,000"MA <br /> ,Saco snnrntctaul <br /> ;4 <br /> X CHECK UQX TO 034MITE R6MU=r-37, &00 joc I '.J,- <br /> TH 3 Mnpa=DAYS <br /> SIGNATURE of:AFFUCANT MATE <br /> At I i't, F <br /> -7 <br /> 4 0 <br /> 10 <br /> -To I <br /> 5p.L 11,ve-a 1.,:5-+. CIO/ r4P-t—Lc;%-c <br /> C <br /> 1pr <br /> UNW-1WRaLIND TAUK;U=)c6uwp 4=-) 0 %�U=Mi jffacua Va.=FAcraN <br /> FOM PA=W M at=VvASMV0n= <br /> UN=GRQWW TMK=W=Mcu"EW0VAA4 M wGiumso. 0:CAM <br /> E2 MOMMM!FA14H M PKIO TIMATMMW PLAMr <br /> 31 Ills t;U z&=Pxb-f 0 M=rr- <br /> � 13 PUR <br /> MMTMCt- <br /> XffAR=- <br /> 13 7ATT04A==YTQ POOtJ <br /> I M <br /> C UMCA%LV"=[:A== PUM=ViATM SysTM a <br /> 2. flat uptotarn nddroosesinthlaapp abo". egWg;t the typc(s}of jatmfr=% t"jW2bav8byGhQQWn1z <br /> tho appropriwa om%(%z). At iu=one aw W"MUST be seiected. amanW <br /> EM to M)4f"131L 9 <br /> SWAMfils iniflojed AkRXQ- <br /> 2 hi <br /> M'D VAU rwiltj the qMftaft. It any MiD fdom O*ftt AT,Mpwntment forr MV1WW W ba conra. ad <br /> SPIAM trtts Y fives busin"s days but na ixtat than ton(161 days Uttar rmciptnf 2NAcadcn. The M9z <br /> will be hold flat mazim=of five bu3ummm daMM ftr r&Aqw. Appaintmants shoWd bo scheduked <br /> 3. A M Qmt in axavety Wng workmd on <br /> try RHO stdf tray nct Wk imn0dilftlY OvufftW f0t mviaw. A now <br /> appiwatla"rMy be Mdawtbw Wfum the film is zVlawn, <br /> 4. Any On cat mumed In the alms cmdWOn ci fSkmand WHI bei re arg4niznd by FAmzbzff:%C the ax;wnzo <br /> of the*;;MlcaM FuMm file reviews try the a"J <br /> 'rENTATME aWofMmant dates must b . LPPflc=may require a M.00 depcmik prior to teview. <br /> ftc�o ramd with MID 4W. <br /> rcc%Wj2d UW next tLusinAasx xray.A4mlicatlarm rec:afy4ad xttar 3=pm Witt vvel ba ba p <br /> CONFIT MED APPOWTMOTT DATE TLIAF- <br /> QA-M CONFIRMED " 1.,. PHO FAX INMALS <br /> YES nla <br /> 4-K-Zy%4 &WAW REVIEW t3Arr= <br />