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,ueo—Phase Environme FAX N0, 2095690295 Mar. 15 2002 04:30PMi P2 <br /> ti•, z,�- =,;._` + ,',; HFA NTYP CES <br /> E t. E .L DI VI ION <br /> 04 W AVi=NUE,THIRD FLOOR <br /> 02 JjVAJR 15 PH � 02 (203)a C 05202 <br /> 1. PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT__ Tele _SUSINCSSIAGENCY B 1 <br /> ADDRESS]?.3,7 <br /> PHONE! 9 X17.3 - FACSWILE <br /> TENTATIVE"APPOINTMENT DATETIME <br /> (Please give 7 of &SIN <br /> tlon 5 Waal) <br /> 0 <br /> HECK BOX TO.F.XPLDITERGQUZST-$©7.00FEP[ SE <br /> 5DAY5 <br /> SIGNATURE OF APPLICANT DATE <br /> FILE Apl7RE55 TH15 51DE EHD$TAFF USE ONLY <br /> 4 PROGRAM ELEMENTS SEARCH <br /> ,n d ar <br /> er-.T Sr. Yo 5-2k R157 <br /> sr.r s/06-W d00 / 7'� ec G <br /> F <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDL-RGRQUND TANK(UST)CLEANUP SITE(LOP) d HOUSING A13ATEMENY ❑ SOLID WASTE FACILITY <br /> CK OTHER CLEANUP SITE(NON-LOP) Q FOOD FACILITY O SOLID WASTE VEHICLE' <br /> Q!, UNDERGROUND TANK(MONITORINGIRCMOVAL) O DOG KENNEL 0 DAIRY <br /> Q HAZARDOUS WASS9 GENERATOR O CHICKEN RANCH O PKG TREATMENT PLANT <br /> O TIERED PERMITTI�1)FACILITY 0 MOTEUHOTE-L ❑ PUMPER TRUCKIYARD1CHCM TOILETS <br /> Q TATT00113QDY P14IRCING fl POOL/SPA ❑ LAND USE APPLICATION S1TE5 <br /> MC01CAL WAsTI!FACILITY O PUBLIC WATER SYSTEM 0 OTHER(PLCASE SPECIFY A13OVE) <br /> 1. List up to ten addresses in t110 space above. Select the typq(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fox-to-(209) 464-0138 or mail to the <br /> address 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 no later than ten (10) days after receipt of application.,The files <br /> will be field for a maximum of five business days for review. Appointments should be Scheduled <br /> accordingly. <br /> :l. A Tile that is activciy being worked On by EHD staff may not be Immediately available for rcviow. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EH0 staff at tine expense <br /> of the applicant. Future file reviews by the same aliplicant may require a$87.00 deposit prior to review. <br /> 5. `TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:05 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATETIMI.: ` <br /> i . <br /> i DATE CONFIRMED PHONE FAX INITIALS <br /> [REVIEWED YES NO PFVIPW nnTC <br /> ,.m ,.µ <br />