Laserfiche WebLink
.eo-PTav,ron Inc. FAX NO. : 2095690295 Mar. 26 2002 09:49AM P2 <br /> N AQUIN COUNTYPUBLIC HEALTH SERVICES <br /> l f�NVIRONMENTAL HEALTH DIVISION <br /> 3017 'THIRD FLOOR <br /> C , szoz <br /> ��W... ?: 19 B� 43 9"4 o <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANTBUSINESSIAGENCY <br /> ADDRESS_,?g3 7 ey � y <br /> PHONE Oy29FACSIMILL' e7 ° , <br /> TENTA SIVE•APPOINTMCNT DATE � O,til/ri y� TIMI: <br /> (PlcasC Oji 7 job �es� lom (aA/USINESS <br /> on submllWl) <br /> GXCHECK BOX TO.EXPEDITE REQUEST- 07. 0 FE — , <br /> � 5 F RE VEST PROCESSCD IN OAP$ <br /> SIGNATURE OF 4,PPLICANT DATE C <br /> FILE ADDRESS THIS SIDE EHD STAFF U512 ONLY <br /> PROGRAM ELL•MENTS StARCH <br /> r2 Ma QT a..)rte Ca-� xS" 31r;-� 0.ML. <br /> L <br /> 3Ss-4 <br /> C/ � <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ADATEMENT ❑ SOUD WASTE FACILITY <br /> Q OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY O SOLID WASTE VEHICLE <br /> }�UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL 0 DAIRY <br /> ❑ HAZARDOUS WAS .�GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> O TIERED PERMFTTSD FACILITY D tAOTELIHOTEI, ❑ PUMPER TRUCKlYARDICHEM TOILETS <br /> ❑ TATTOO/BODY P,tdIRCING O POOlj5PA El LAND USE APPLICATION SITCS <br /> ❑ MEDICAL WASTC FACILITY 1 ❑ PUBLIC WATER SY5TEM ❑ OTHER(PLEA5E SPCGIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any END 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 held for a maxilnum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. 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 EHQ staff at the expense <br /> of the applicant. Future file reviews by the same applicant 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;00 pm will be processed the next business day, <br /> i <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONF1RMEL) PHONE FAX <br /> INITIALS <br /> REVIEWED YES Np REVIEW DArI= <br /> e., ao a oao>,00 <br />