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,ac—Pha viro to 'IC. FAX NO. : 2095690295 Mar. 26 2002 09:49AM P2 <br /> :IN1AQUIN COUNTYPUBLIC HEALTH SE t° <br /> �NVIRONMFNTAL HEALTH DIVISIONRVICES <br /> �; rt Iii <br /> 7HlRp FLOOR <br /> I�' 2' i`j 0� 43 s202 <br /> 02 . ., <br /> ( ) No <br /> - -- — —_ PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT_, �a.yti- �SUSINESSIAGENCY <br /> AODRESS e2 3 `� <br /> PHONE_3'6y daq ,"+ <br /> FACSIMILE <br /> TENTATIVE'APPOINTbICNT OATL" a V/ 11-y <br /> (Plc.sc Oji 7 10 b Lincs• TIME - <br /> ' tocn�l applic ort submllla(} <br /> CHEEK BOX TO REQUEST.$07. 0 FE _R UES7 PROCESSED 3 USIN[S5 DAY • <br /> $ 2 <br /> SIGNATURE OF APPLICANT -- <br /> _� DATE <br /> S FILE ADDRESS THIS SID[EHD " <br /> STAFF U5E ONLY <br /> ✓� MO T PROGRAM ELEMENTS SEARCH O <br /> Q•.?ns! Cdr •.txs p �, <br /> ✓, en1 c4�k I"ld /rr <br /> ( `- <br /> ,. <br /> urs <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ,WUNOCRGROUNO TANK(UST)CLEANUP SITE(LOP) D HOUSING A13ATEMENT ❑ SOLID WA5TE FACI1 1TY <br /> O OTHER CLEANUP SITE(NON-LOP) IJ FOOD FACILITY O SOLID WASTE FACILJT <br /> l�UNDERGROUND TANK(MONITORING/REMOVAL) b DOG KENNEL <br /> ❑ HAZARDOUS WA5 .E GENERATOR b DAIRY <br /> O TIERED PEPM TTSD FACILITY ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ PAOTI U <br /> O TATTOO/BODY Pf3(RCING HOT1 O PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ MEDICAL WA5T8 FACILITY ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ PUBLIC WATER SYs.TEM O OTHER(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 5eleetcd. Fax to 209 4G4 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 /> accordingly. <br /> 3. A file that is actively being worked on by EHD Staff may not be immediately available for review. A new <br /> 4. <br /> application may be submitted when the file is available. <br /> Any file not returned.jil the same condition as released will be reorganized by EHp 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 /> G• Applications received after 3;00 pm will be processed the next business day, <br /> i <br /> CONFIRMED APPOINTMENT DATE <br /> TIME <br /> DATE CONF1RMEp <br /> PHONE FAX INITIALS <br /> REVIEWED � <br /> YES NO REVIEW OATt= <br /> e°, oo a oao>�oo ' <br />