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1a. z , <br /> ANI JVQ61N COUNTYPVJ3L'1C HEALTH ScRVIGE."• <br /> r 'NVIRONNIF-NTAL HEALTH DSVI$lON <br /> 304 EAST W£BICF AVENUF,THIRD FLOOR <br /> Rol))468-3420 <br /> Z��IJBLIC RECORDS RELEASE APPLICATION <br /> APPLiCANT; LC 6% _U{JSINESSJAGENCYRZ1/,ry ° �-_ — .�.«0f„ <br /> AcOrtess' r�7/) LcwiJ //7 . <br /> PHONE OR,,T GG _ �S' /� -• _.....__�_..._-_— <br /> FACSJastr <br /> TENTATtVF'AprouJ7MCRT OATL <br /> (PlGaw,ryiyc 7 to try bunineSS VS fromU <br /> ca3 app11G0[iM.ubuull}Ij <br /> CHC-Clf r'3 Ox YO,EXP!IJI7E RCQU4s7 cFE' C <br /> -:si+'nOCEd U7 'U$3NE'$ DAYU <br /> SIGNATURE OF APPLfCAN- S!/ <br /> TRIS S W L EHD FTAFF USL•<)NLy'�`•�� <br /> P� PtyGliRAHI ELERtL-NT::SeARCH <br /> dl>TPrF 1�/rf <br /> F-NVIRONYIPNTAL HEALTH DIVIsION FILL'ii <br /> U 4r=RG4OUNV 7AIAK(UST)CI,-r gf:UP 8 rp C OPJ O HGU54YG AAATEMENT <br /> JOjMCR'CtEf,NUP SITE(NOyI-LOPy L+ OD �+ •�bL1U 1ryA5T[ FgClt[iy <br /> DERGKOUND rAXK(MONIToRINGIREhIOVAU D DOG KENtrct ' o SOuo N1WEVE%CLE <br /> IIAZAfjOOUS WAFTS GENERATOR U KEN D DAIRY <br /> -mi=PCRtarrTkU rACILIYY ca CHIC)rEalurLuN AMCN d PI(G TALATMrNTPLANT <br /> O 7AYTDOJBODYPUFACILI d PUMPER TRUCHq-ARDICHEM,TOILETS <br /> Mp;p1CP.,L^ryq&TE FACILITY U POOVSf+A ❑ LAND USE Arra• C <br /> N SITES <br /> p PUUUC WATER sYs;.mu CI OTHEN(PLr.ASE UPrC1 Y A13 YEJ <br /> 1 "ist Up to ten addresses in(Ile <br /> space above. 5elt qt the type(-) of flJas from the list abovu by chocking <br /> the approp:;;e, t boxb uvc A2 least one file EYpc MUST be selected. Fa, tr. 7.U(J q�138 or m. ; t th <br /> adtl ss iodic t ri abevo. �k <br /> BHD YMI,-hotif the a <br /> Y pplicant if any FJID files exist. An appointmcbt for rcviow will be Confirmed <br /> approximately five business days blit no Jatar than (on t1 D)days af(crrce&ipt c(appfrcalion. 7hc lffes <br /> aCC I' ,geld far«marimumoffivebusinoscdaystarraviCw, AppginhncntAshouldbe&ChadWed <br /> . A file that is activel <br /> aAPliy being worked on by£HO staff may not be imatediately available lot review• A new <br /> catior may be suJitlittoC+when tha file(a Qwdlable. <br /> A• Asly 1110 net r cturnod in Inc same condition as rweasccr will be rewiyarizeH by END,tact at the cx <br /> Of the appttcant. Futlrre Gig ravtcws by the sama ap'Pticantmay rrlqufre a$87.00 daposlt y:Jar fo revlt.•». <br /> 5 71ENTATSVE 20Poirttment Cater,must ba s P9�c <br /> t• Applications I•ecUived after 3:00 pm wilt bEDnfi;mcd wi`h EriD staff. <br /> processed the next bUSinP.SS day. <br /> CONFIRMED AppC3JNTMENT <br /> ---- �_ TIME <br /> qA'T�CON'F{RNSFD .�.. t <br /> t v 1 <br /> FZ. tN1TIA_�VIEWED; YL� !•A7C <br /> L 1 w�� .ON6 a N V RBVJ�lY DATA ~��. 1 <br /> i <br /> PAGE.:1 <br />