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.eo—Pha won t�nc. FAX NO. : 2095690295 Mar. 26 2002 09:49AM P2 <br /> N pAQUIN COUNTYPUBLIC HEALTH SERVICES �•........... <br /> "•'! -���f ENVIRONMENTAL HEALTH DIVISION <br /> 30 ,THIRD FLOOR <br /> "5? szoz <br /> 02 W.'. 26 W8 43 ( "4f0 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT_ -101le Am""Irk;'- BUSINESS)AGENCY_�CO <br /> ADDRESS e2 3 7 k1 <br /> PHONE_ 3`6± OA'7 3FACSIMILE' W O Fr <br /> TENTA'rIVE'APPOINTMCNT DATE TIMC 117 <br /> (Plc�sc ei 7 to pjjjj�����eS` lo�n (apptic on;.u6lnllLaI) <br /> • <br /> CHECK BOX TO,EXPEOrrE REQUEST.$01. 0 FE R UEST PROCESSE�N 3 USINESS DAYS 2 <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADORE$$ THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH O <br /> Vi. C1I.P.0 aro Eta,• <br /> b t• 'y <br /> s 5 11 eti ca 7 e�iw/. <br /> Ji r I�✓� ore f W,-eczt <br /> I <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> XUNDCRGROUNO TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> O OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDERGROUND TANS((MONITORING/REMOVAL) O DOG KENNEL O DAIRY <br /> ❑ HAZARDOUS WASIE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> C TIERED PERMrrT50 FACILITY ❑ MOTEL(HOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> 0 TATTOOIBODY PUIRCING ❑ POOVSPA "" 17 LAND USE APPLICATION SITES <br /> ❑ MEOICAL WASTd FACILITY 1 ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPBCIFY ADOVE) <br /> 1. List up to ten addresses in the space above. Select the types) 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 EHD 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 maximum of five business days for review. Appointments should be scheduled <br /> accorclingly. <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 EHD 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> I REVIEWED YESNo REVIEW DAr1= <br /> ei� o .oaovoo .1, <br />