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.. ... AN <br /> 40 COUNT,Y;,e <br /> ami --It ac <br /> PUBLIC "CORDS RELEASE APPLICATION <br /> APPLICANT:. S <br /> ltm�j . BUSINESS/AGENCY:-10RA(SU, <br /> ADDRESS: VC) eU4 qSWI <br /> PHONE(1): . OD at) PHONE(2):a QR-0'74a FACSIMILE w' <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQLftT-$95.00 FEE ASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: El List E] Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> --Street—# Street Name City <br /> Unit I <br /> PID <br /> A <br /> 2. V9—CSINE I�Iak 15 <br /> Cr <br /> 3. 1W <br /> 4. Unit 3 <br /> 5. <br /> 6, Till Unit 4 <br /> 7. kCANNLu <br /> 8. Unit 5 <br /> 9. <br /> Unit 6] <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING A13ATEMENT m WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(Non-LOP) FOOD.FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY MOTELIHOTEL PUMPER TRUCKIYARDICHEm TOILETS <br /> TATToo/Booy PIERCING <br /> POOLISPA LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY)_ <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 Am-5:00PM - EXCLUDING HOLIDAYS, <br /> I.. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to.1209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted–for additional assistance with file addresses,contact the EHD.Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) <br /> days after receipt Of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EPIC)4M6 5116/2007 <br />