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M' : ETICENGINEERING FAX NO. : 19256024718 23 2006 12 : 55PM P2 <br /> 03/ 22 / 2006 16 : 52 4640138 ENVIRONMENTAL HEALTH PAGE 02 <br /> UMI � ,triJ'kIVl+Ug <br /> xW09 ( ./C APPLICANT; XWSMESSIAGENCY; ( iC E ✓WIKrcr AsGn�i 4�i j� XaTATE, (�. <br /> },( PHONE (T): qZS fT �rr} tt� LOXI3. PHONE (E): q xAGSN'AIIE: ,�d. <br /> TF..NTATW APPOMTIAENT DATO: Q, Z Time; A2 0M. . <br /> `�,(' (Please allm td buefRaaa days from date of appumm� to im • arenmWe miy4 must be ew&rmed) <br /> 7 �� qL CHECK BOX TO EXP2DrrE 1W Lmai a 6s .UO F E (CASH 0 CHaOK ONLY) - REQUEST PROCESSED IN 1 USINE98 OAY$ <br /> SIGNrrrAT---URE OF APPLICANT DATE ��_ <br /> EFacttOniC p Llst d MNONNI Er <br /> ap - De4cripeeR _ <br /> InfwmaUon <br /> FILTH ADDRESS EHD UUS ONLY <br /> slroatl <br /> shpat Ramo OHy <br /> 0 Unit 1 <br /> Ea Unit 2 <br /> s Unit 3 <br /> T. <br /> s. _.,. Unit <br /> s. <br /> $peciHo Date Range of Infntmahon Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UMandaO1N4DTANK (VST) CLFJJa1P SIfE (1-OP) ❑ HOVSING ABATEMENT 0SOtIDYIAV1A FAdLITYIVEIticI.@ <br /> ,v ERCLP.AN'1PanE (NON-LOP) 17r�OWFACWdty ElWAWTM <br /> 6 UNDERGRWNB TANK (MOUTURNGWWOVA4,) ❑ 0DO MKIZI, ODAMY <br /> U HAzAMUS WAaTA OWNIRATIM 0cKmrjm TOM 13 WADtWATERT",A7RENTP6Atr <br /> 0 TIERED PERIFAaLRT U MoTELIHorEL o PUMPERTRU"NAF9 trEwcALT0U?2 <br /> 13 TATT6oMcoY PmRQM 0 130"PA t7 LAND WE APPUCATM a40 <br /> O MEDICAL WASTE FACILITY t] 0T1(ER(PLFJVSE aPWDIPY) <br /> w6txmDaSPTAPEp:MITftECOR1DSANEAVAWLAPDRls eWmMONDAY.FROAYOIOOA":BOM 0 (OI.AVr. K0UDATe. <br /> 1. LITH up to tan addresses in the space AbOYaa, Select the typa(a) of files from the list above by checldnp the <br /> appropriate box(es). At l6ast one file type MUST b6 selected . Fax to (2(19) 4B4gL� 86 or mall to1 . <br /> the address <br /> IndlOated abo Address ranges will not be accepted — for additional assistance with file addresse% concontact <br /> tha Elip, Applications received after 3 :00 pm will be processed the next buslness day, <br /> 2, The EHD will notify the applicant tf any EHD files exist. An appointment for review will be confirmed <br /> approximately ten (10) days after receipt of application. The files will be hold for a maximum of five k"PsIrIess <br /> days for review. Appointments should be scheduled accordingly. <br /> g, A file that is actively being Worked on by EHD staff may not be immediately available for review. A neral <br /> application may be submitted when the 1116 Is available. <br /> 4. Any file not retumW in the same condition as released will be reorganized by EHD staff of the expense of the <br /> applicant Future file reviews by the some applicant may require a $93.00 deposit prior to review. <br /> ExO Laos <br /> �O/STIyea6 <br />