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V•:.� --1 j'"4..1 i It�• .-7 J-I` '.�'L a`a L inti ti 1 l ` <br /> 4 vv a� �vUa �. i Rt... 2 LUt-�T 1 i•ii_ J 1 LY`1.�.s-.�v-ti r 1' t�.� <br /> .w I u P.01 <br /> �?AWIN COUNTYWUSLIC HEALTH SE VICES <br /> ` `✓i - l i!1`i__I' '`ill r �j! HEALTH DIVISION � <br /> C v,� ENVIRONMENTAL. <br /> V , 304 EAST WESER AVENUE,THIRD FLOOR <br /> M 1 9 2001 sroc2og asBaia2zlt� <br /> -- <br /> ,� 5LIC RECORDS RELEASE APPLICATION - <br /> ( r $USIfIES$/gGENCY Nr IQJ�\ <br /> jo <br /> I 4 <br /> FACSIMLLE_ �lig• J J �J�LO <br /> TENTATIVE'APPI;A ITMENT PATETIME <br /> R <br /> -(Please give 7 to 79 luus-1-5 Oays iron Cste DI bpprcatian subtriMoi) <br /> EE° <br /> CHECK$QX TO EXPI=U)FE Rt GU .00 FEE_RE.QUE ROCESSED IN 3 BUSINESS VA TQP <br /> 5iGNA UR OF APP>`ICah 1 DATE <br /> l <br /> F DESS T8-M SICK EIiD STAFF 115E on Ly <br /> be^"SAM ELEMENTS w-ARGH <br /> I?Z I`«fJrJJj�•.'�o?. ' l�C- _ITNt C <br /> 11+r <br /> I I <br /> ENVIRONMEN AI_NTH DIVI51019 FILES <br /> 4. <br /> X1 Ut90F.A1a11QWND TANK(rJ31f)r4Attur SITE(LOP) fl NOusirle"^-rt;NEt{T Q SOLA?WASTE FACILITY <br /> 13 OThER CLEANUP SITE(NON•LQP) 0 F'DOO FAQL1 fY !,. 0 SOLID WASTE SAH=-E <br /> UNDERGROUND TANK{MONiTORMG MEMOVAL) Cl OOG gENNL-L C1 DAIRY <br /> HAZARDOUSWA3TEGFNEFIATOR E3 GHICKILK RMCM 0 PILL7kCEA7Ai"TPLAHT <br /> i7 TIERED PERMITTED FACILITY i E3 MOTEUNOTEL 0 PUMPERTRUCIUVARO/CHEM TORATS <br /> TATTOomoDY pinaci IG ; f5 P00e.JSPA ❑ LAND USE APPLICA130N SITES <br /> MEDICAL.WAM FAMLITY JO PUBLIC WATER SY5TLIA 13 OTHER(PLEASE SpECLFY ABOVE) <br /> 1. List up to ten addrksses in the space above. Select the types)cif ties from the fist above,by chocking <br /> the approp4riato box(us). At least one file type MUST be selected. jQ.{ Q91484-C11 A ar m_a�Ii to tree <br /> address indicated�bave. :�. <br /> 2. EKD W111 notify the4pplicant if any EHD Max exi-st. An 2ppnintr�61)t forreylew wili be confirmed <br /> apprOxiMately Live;business days but ria later than tan(10)days a{ter receipt of Applicatlun. The tiles <br /> will'be held for a maximum of five business days forrevjow. Appoln1 menta should be scheduled <br /> a crosrding ly. il; <br /> 3. A fife that 13 acW&Iy baing worked on by EKD staff may not be immediately available for review. A new <br /> application may be subinitted when tha file is available. ,i. <br /> 4. Any rile not returned in the ssme condition 715 rellpAved will Nae reorganized byr EMD staff atthe.expense <br /> of the applicant. F66:wo fills reviews by tine same aW1Cant may retlulre a$87-00 deposit prior t4 review. <br /> S- "TENTATIVE appo'tmant dates must be confirmed with E1113 vol. <br /> 6. Applications recOred after 3:60 pm witl be proresaed the next biRsinexs day. <br /> CONFIRMED APPOINTMENT DATE <br /> DATE CONFIRMED PHONE FAK '' INRIAt_S <br /> REVIEWED YES NO REVIEW DATE <br /> 4"va x eaoJioo <br /> TOTAL P.01 <br /> E! <br />