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1 --k_J%.j A .1 V d _i,k k, <br /> IU: <br /> 191GM23-454 P.C2 <br /> OATS W.OiWrM "VICES <br /> � <br /> OAQUIN COUNTYPUBLIC HF <br /> rE%WD SAENVIRONMENTAL HEALTH DIVISIOFf <br /> 304 EAST WEBER AVENUE-,THIRD FLOOR <br /> V1 AR 17 2000 STM(209 <br /> 4 <br /> NA401107 il <br /> 11 1, <br /> HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> ,'-- <br /> EL 6:peASA�BUSPRESSIAGENCY ?2Q"jq <br /> -F (A t?su <br /> a SIAIT —_ILL <br /> (�9 <br /> AJDDAFS5 j�AVL <br /> PHONE Nk <br /> TEKTAMVE!APPOOITAIE"T OATE <br /> (plasm givo 7 W 10 b6WIT055 d*Y3 ffir—om kppioldrt <br /> CHECK 91DX TO EXPEDITE KEQUES .00 FEE-RFOLEST PROCESSED IN 3 BUSINFISS DAYS <br /> 4� 3A7 <br /> 6 DATE <br /> SIGNATURE OF APPLICANT <br /> TM 34DE END STMT UGE NIrY <br /> FUER A)REiF I i L pRA"RW CLEMEM SEARCH <br /> It <br /> ij <br /> ij <br /> EWIRONMIENTAL HEALTH UPASION FILES <br /> UNOERGROOND TANK(UST)CLEANUP ZffE(LCM Q HOUBIXGABATFMGNT :� C1 SOLM WASTE FACILITY <br /> K <br /> rmL OTHER CLEAROP SITE(NO144-OF) 0 FOOD FACFUrrY JU SOLID WASTE VEHICLE <br /> 41 <br /> M UNDERGRCMMI)TANK(mo#4rroRjNGmeA*OvAL) 0 DOG KEKHRL t)41fiY <br /> 0 HAZARDOUS WASTE GEW-RAT04 0 CKCKENRARCH IL ;iO 13146 TREATMENT PLA KT <br /> 13DIMLA40TEL. ij ro PUMPFIXTRUCKNAMCKFATO1113 <br /> I <br /> C3 YWRED PERMIrrM FACAJTY 13 LAND USE A"UCATKA Sebes <br /> 0 TATTO&SOCYPVRCING 0 POOLPSARA <br /> 0 MIEOICAL WASTE FACILITY 0 PUNUC WAM 5Y5TeNt. 13 OTWR PRIAMIE W00CWY ABOV10 <br /> j <br /> List up to W1 addM"gs in tne space above. Select the type(S)ofllfft3 from the list above by chockin <br /> the appropriate box(es). At least one fila tYP8 MUV be sel acted.f=to(2091454-0938 or fliall to 110 <br /> 2. EHD will notify the*Wkmt If any EHD files exist An appdintment for review will be conflnTmd <br /> appointment <br /> appr"M3W)ly five business days but no tater than ten(10)days OW receipt of application. The Gies <br /> will be held for a maxktrum of fl"business days for rovla4i. App�6jntmenU should be scheduled <br /> accordingly1) <br /> 3. A file that ts..actively being worked an by EHD staff may not he int!edlataly available for roview. A no <br /> application maybe a ubmitted when the file In wral[&NO. ; I <br /> 4. Any fila not reummod In the same condition as released will be real rganIXOd by EHD staff at Jh**aspeng <br /> of the applic-ant. Future file reviews by the xMW appllcanimay require a$79-00 deposit prior to revsa <br /> s. *TENTATIVE appointment date*must be confirmed with EHD staff. <br /> 6. Applicabons received after 3-00 PM Will be Processed the i next Wsin*65 day. <br /> CONFIRMED APPOINTMENT DATE <br /> DATE CONFIRMED PHONE 'TAX INMALS <br /> REVIEWED YES No REVIEW Waik <br /> an tv rd abnw <br /> TOTAL P.02 <br />