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.eo-Phe viro'INl <br /> Inc. FAX NO. : 2095690295 Mar. 26 2002 09:49AM P2 <br /> � AQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 301 <br /> IT MTHIRD FLOOR <br /> s2ox <br /> 02 Hp 2 W 8: 43 ( ao <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 5 -�e Za 111/0.2 P' SUSINESSIAGENCY <br /> ADDRESS o2 3 <br /> PHONE FACSIMILE <br /> TENTATIVE•APPOINTMCNT DATE O >/ 4" TIME <br /> (Plc�sc Oji 7 �FE <br /> 0 b�c.$ MnW f ak3/U51NESS <br /> on aubinittal) <br /> CHECK BOX TO,EXPEDITE REQUEST-$07. 0 -RE UEST PROCESS[b IN DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> FILE ADDRESS THIS SIDE-END STAFF USE ONLY <br /> PROGRAM ELE-MCNTS SEARCH <br /> z Ma 4 7` a..l'c c� Cdr-,�.�ss o •, S t~ .t140-AA t- <br /> 6 �-�' ate► c car J7 /*,^ c'D <br /> a r -4 L <br /> 4 5 N a y rr oa p` e T rw/. <br /> !21 9Z-- <br /> �, •rr 35 .4 <br /> ENVIRONMENTAL.HEALTH DIVISION FILES <br /> ,WUNDERGROUND TANK(UST)CLEANUP SITE(LOP) Q HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> Q OTHER CLEANUP SITE(NON-LOP) © FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) O DOG KENNEL 0 DAIRY <br /> ❑ HAZARDOUS WASSFGENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> C] TIERED PERMITTEDE FACILITY 17 MOTEL/HOTFL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PiiIRCING ❑ POOLi-5PA ❑ LAND USE APPLICATION srrL•s <br /> ❑ MEDICAL WAST8 FACILITY 1 ❑ PUBLIC WATER SYSTEM ❑ OTHCR(PLEASE SPECIFY AUOVE) <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 EHD files exist, An appointment for review will be confirmed <br /> approximately five business days but no later than tbn (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 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 EHl)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 CONFIRMED RHONE FAX <br /> INITIALS <br /> I REVIEWED •� <br /> YES NO REVIEW DATF <br /> r�+cn �. •oaa�roo <br />