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[Icu. :ilili U,-,. <br /> P.02FAX NO. �C9`�a�: <br /> G <br /> �:Oh Goa - 5696255 <br /> V m <br /> r.1101 12��G �' - �,o wc:a►N.ai.x <br /> CJ) QUIN COUNTYPUBLIC HEALTH SER <br /> f L ��LI 11 D SAS �OENV RONMENTAL HEALTH D VLS'ON VICES <br /> T�,�F.SF.RAVENUE,THIRD FLOOR <br /> OCT 2 5 2000 <br /> $ s XrOCKrOXCAsszox <br /> (2011)40-3420 <br /> NVI�ONMEI�T HEALTH PUBLIC RECORDS RELEASE APPUCATION <br /> P i � � E <br /> �pPl1^ + ;4rr eusinE59laGEt[cY ! <br /> .� t— <br /> t' <br /> " Ff,GSI1dILE 7� � 7 <br /> A ifb !S• <br /> y� TEKTATIVt;`APPOtNTUANT DATE ME <br /> (pi"zo 21vo7 tv 94 pusirwss days tram data a1aP91u=tl0n4Ptfamtlts <br /> CHECK BOX TO EXPED[TE KFbg13EST PROCESSM 3 SUSLNEG$GAYS <br /> �iGKATVRZ Of APPLICANT DATE. <br /> E t <br /> FI.MODRESS $T U QNLY <br /> PRQGRM ELEMENTS SEARCH <br /> 12 <br /> L <br /> i C4 PC" a <br /> ^77 <br /> 42 W <br /> ' nsa <br /> � A - <br /> S EHViRONIAZNT'AL HF�ALTH 1]MIWN FILES <br /> UNDERGROUND TAAK NST)CL M1UP srTE JLQP) 13 s'iottsiNG Af3ATWr;NT 11 SOLID waste Mctuyy <br /> OTHER GLEANUP W9(NCX4 Lop) Cl FWD FACUry - 0 KUDW Trz vFttle per <br /> 00 UNDERGROUND TANS(0MONITOR NWRFiMOVA.) ❑ 1003 KEMF-L 0 "Ry <br /> 9 KAZA=U3 WASTE GENERATOR © MCKI2H RmCK Cl PKG TREATblF.I+iYPLANT <br /> �1 TIERED PERI Mrzt)1FAC 1IWTY D MGTEi Kgj-6L 0 PUNPIR TAU WYARDI MEMTQLA S <br /> Q TATTO"ODY PEIRCMG Gl pootFspA - - 0 LAND U89 AWUr.ATION SITES <br /> 64EMML WAA$T9 FAGruTY 0 PU81.1CWATERSY5T6AI Q OTHERtP�SPFCIFYABOVE) •• <br /> �. List up to ten addreasec bi the space above, Selcct lite type{s}Gf f1Ees from the flet above by checking <br /> the appropriate box(es). At least one filo typo MUST be selector!. Fax to( <br /> 2d9� � a;malt to thw <br /> � � t <br /> ,.m,1.� . <br /> 3. EHD will n0117y the app13eAnt 17 atay EKD f9as exiaL An appointment for review win be confirmed <br /> approximately five business days but no later than ten(10)bays after recelpt of*ppli"tlarL•The friss <br /> IMU qe held for a maximrn of fivL business days for r oview. Appgir <br /> rcordingly. ttrriants sloatli be scltedu[ad <br /> s <br /> . Afiiri tttDlt Is actively being workers on by t;kiD Staff may not be immadialefy aYnHWO for review. A nein <br /> i a>'pli Atlon may he submitted when the file Is avaifabie. <br /> Any fik not raturnad irk thg same ronditlon as released will be reorganIzed by Irbil staff at the axli4f<sa <br /> of the agplfca:ll, .puti�ra fife retiierrs by the same applicant may rogUira a$87-00 deposit prior to reYlaw, <br /> 5. TENTATIVE afypolntntant daie6 must ba cant f=d with RHD staff. <br /> • Applications received after:3-00 pm w;q bQ processed tW next husiiSeSs day. <br /> CONFIRMED APP01WI-MENT DATE TIME <br /> DATE CONFIRMED <br /> PHONE FAX INITIALS <br /> AF-VIEWED YES NO REVIEW DATE <br /> TOTAL. P.as <br />