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,eo'PTavon Inc. FAX NO. 20956150295 Mar. 26 2002 09:49AM P2 <br /> _1 ppAQUIN COUNTYPIiB 1C HEALTH SERVICES <br /> -} I�F�NVIRONIVIENTAL HEALTH DIVISION <br /> 3017 4 ;THIRD FLOOR <br /> 43 S 5202 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT SUSINESSIAGENCY <br /> ADDRESS a2 3 �1-r y A%e- <br /> PHONE d1A FACSIMILL 0 •f' <br /> TENTATIVC'APPOINTMENT DArL-" o iii TIMC <br /> (FlcIse 00A T Q butin rom /I�pplic on suUmiIG1I) <br /> CHECK BOX TO,FX ZDFTE REQUEST-$07. 0 F5 -R U!"SY PROCt 55[ `N 3 UZINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE / <br /> FILE ADDRESS THIS 51D[END STAFF USL•ONLY��` <br /> PROGRAM CLCMENT$SEARCH <br /> Ido ar axTc�r Ca••a,•..ixs o S 1-D IGO.Mz <br /> 7— <br /> LR-4-A' <br /> i -6/ arc c +.7'P i <br /> S/ ar -- -•. L v ,rr1 35.E-4el <br /> F <br /> �._._. <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> XUNOLRGROUND YANK(UST)CLEANUP srrF-CLOP) O HOUSING ABATI MENT 13 SOLID WASTE FACILITY <br /> 0 OTHER CLEANUP SITE:(NON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> ;W UNDERGROUND TANK(MONITORING/RE-MOVAL) 0 DOG KENNEL 0 DAIRY <br /> ❑ HAZARDOUS WAS F,GENERATOR 0 CHICKEN RANCH 0 PKG TRCATMENT PLANT <br /> ❑ TIERED PERMrrr6Z)FACILITY 0 MOTELMOTEL ❑ PUMPER TRVCK/YARD/CHEM TOILETS <br /> 0 TATTOO1900Y PdIRCING 0 POOUSPA 0 LAND USE APPLICATION SETCs <br /> 0 ME:OICAL YIiASTd FACILITY 1. 0 PuaLic WATER SYSTI~M 0 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up t0 ten addresses in the space above. Select the types) of fifes frorrl the Iist above by checking <br /> the appropriate box(es). At)east one file type MUST be selected. Fax to (209)464-0138 or mail to the <br /> address indicated above. <br /> 2. EHO will notify the applicant if any EMD 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 maxiirluM of five business days for review. Appointments should be scheduled <br /> acGordincdly. <br /> 3. A file that Is actively being worked on by!=H❑ staff may not be immediately available for review. A new <br /> application may be submitted when the file Is available. <br /> 4. Any file net returned in the same conaltion as releasicd will be reorganized by EHD Starr 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 bC;confirmed with EHD staff, <br /> 6. Applications received after.3:00 prn will be processed tho next business day, <br /> I <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED r <br /> PHONE FAX INITIALS <br /> .a <br /> REVIEWED YES NO <br /> REVIEW DAT!` <br /> tis ae �• .nerorroo <br />