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U4/x0/2003 08:42 FAX 208 8480021 <br /> Q]002:001 <br /> DATE WflV EHO IDG HUMBER <br /> ni I_ ''. r IAN JOAW IN COUNTYPUBLIC HEALTH SERtYiCES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APR 3 0 2003 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCK70N -3 90 a , <br /> _NVIRut\IMEN I HEALTpH11 (za9) abs-342o <br /> cl-cnG T c 1 t( F$` V ELIC RECORDS RELEASE APPLICATION <br /> APPLICANT BUSINESSIAGENCY /'L'•^�L i_1 Nr- � _w <br /> ADDRESS o'�-8�-5 �s� /✓7Vr4-1.e -5-A- <br /> PHONE FACSIMILE D6 -- <br /> TENTATIVE`APPOINTMENT DATE 5/ /� 3 TIME <br /> i <br /> (Please give 7 to 10 business days from dale of application auhmittal) 7 —7C�� -) <br /> CHECK BOX TO EXPEDITE REQUEST-387.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS I I I/1 A <br /> SIGNATURE OF APPLICANT DATE <br /> DATE <br /> FILE ADDRESS THIS SIDE?EHO STAFF AFF USE ONLY <br /> -(,� PROGRAM ELEMENTS SEARCH <br /> /�76 �Ou, CIV& LYI/G . I _ <br /> OP ( own tr. 1✓1 I vL <br /> 2 10 3 hr r1&k TYNE ) <br /> l ) S I COV. 4Clol <br /> M70,2; <br /> ovn} r CIuS 31✓d ` � <br /> COUA+ . Cla6 / laL <br /> �r rt..6 (31 1Cc-"+r 00-ub 131✓LL p) <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> .0'UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT tl� �EILIO WA.;TE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY O'S(IDD WA.'.i11E VEHICLE <br /> -2-UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL 0 DAIR'/ <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG'rREArMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY tl MOTEUNOTEL ❑ PUMPERTRUCKrYARDICHEM TOILETS <br /> ❑ TAT700/BODY PEIRCING ❑ POOUSPA ❑"U ND USE APPIJCATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHf:R(PLEASE SPECIFY 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(:o /z09) x64-073s ar ma'I o 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 /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for relriew. 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 requirlt 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 busine:is day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX �T INITIA.LI: r <br /> REVIEWED YES NO REVIEW DATE <br />