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Crage`i1 ori'+e'i " €"I"' i 2016-08.0805:23:33 (GMT) 1 884443080 From. Pawel Woloszyn <br /> €j, DATE Ri_CEIv(_0 SAN JOAQUIN COURush <br /> NTY Fki[);LOG NUMBE Y <br /> rGK AUG a u 215is ENVIRONMENTAL HEALTH DEPARTMENT <br /> 106,8 East Hazelton Avenue,Stockton,CA 95205-6232 <br /> •Et Pu`IRt3C�M�� Ham-Telephone:(209)458-3420 Fax:(209)464-0138 We ww'w.sjgov-arg/ehd <br /> prM,&ITlSEi CES FUSLIC RECORDS RELEASE APPLICATION Pacific Environmental <br /> r BUSINESSIAGENCI;_ anaoemen nc, <br /> APPLICANT: Pawel Vdolnsz;�n <br /> ADDRESS 15Q0 W:El.Camino Avenue#220 CITY.(STATEZIP: Sacramento;CA 95833. <br /> .54 -T pem_inr-@yahoo.com <br /> PH?NE:(9):, .9[6-444-16E A <br /> Please allows()business days from date of application submittal for the records to be available. <br /> Staff.witt contact yos(o.atrange an.appointtr±err date and time to review the requested records. <br /> ® tEGM 8,0 1t 1P£yJFi RE6ll 5T,'S '9FEE.(G }1338 GfiSGK p1 LYJ,'; EII JE5TP 0GESSED+t BLUIfaESs DAYS. <br /> SIGNATURE OF APPLICANT :�...�9A� _ OATS B!8/16 <br /> 1. List u¢io ten addresses inthe space,below. Seleettfte type(s)of files from the.list below by checl;ing the appropriate <br /> box(es). At teast:one file type MUST he selected. Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges wilt not be accepted.Applications Teceived after 3:00 pm w¢ti be processed the next business day.. <br /> 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted above. <br /> 3. The EHD wtl l notify the applicant if.anyy EHO files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The Ties will be held fora maximum of five business.days-.forreview, Appointments <br /> should be scheduled accordingly. <br /> 4. Any file not returned in the same condition as released win be reorganized by:EHD staff at theexpense of the applicant. <br /> Future file reviewi.by the same applicant may require d$13'9 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑List❑ Map-Description: <br /> Specific Date Range of Information Requested: From Alt Avai?able to <br /> EttV1Ri NMFN . <br /> i E&LTH L EPAR?f�E"T FILE:A€lDRESS <br /> F(LES EHE? USE ONLY <br /> ®UJOFRGMIND TANr(UST) Street Streat.Rame. City 1nh,V� �q•�1�eLY,V�1I��1 pi�;��1/ <br /> 2601 TccPe`Dztve. Stockton <br /> L}fY.ER CLrYiNUP SITE iNGR-Lost" <br /> HAzAmoa wAem. p D<W�IS <br /> 71E—Pswm'to FAPAL 2455' Tcepee Drive Stockton <br /> ®UST-( Rpu:rr *i <br /> ©i1St livteN..9'1mGi P, Metki). tOCi'tOlt <br /> a 2365 T epe::,Drive S. IVB/ <br /> �11a:�Aroous MAz�i^!s' <br /> �S�Yi(RELE55£I3ESPGYilSL- WFTEN.GM1I%LVT' <br /> p5onwssSFaumVvwcE y 273'$ N I¢epeC:D[ivC StUckCpn (fit <br /> F1 FOOD FACVi _ 1 l/� <br /> F1 PoO_!SPA E1j Zrre tdlyuei,aN <br /> ®Lmo USE'APPLIG4,ll ETES. <br /> ❑sEc'nc,PUWM TAu ro <br /> Y.wul Pialic l ro1LUS <br /> ❑Wh+TEYr':ers::[tE.•:f�ENTPLaNT rvvF3. <br /> ❑.HOIt51N6 A5niEMINr' 7 <br /> MOTS#�o� CUPA.JS'r <br /> Cn,pKE.N}7AkCa I D[n>KEw,e! <br /> Q LIEpCCrtL WASTE FAG 'a' J <br /> ❑TAID apOYPLRUNG p�5txv wA51 E. <br /> \'.'hsE Trt?E S <br /> �:CpuPusnr <br /> OTtfER(F'LEASE SPEGIP.'k ❑Ar�wxi:ec <br /> wfiterweli&-septic system 'to <br /> �^ '^'e GXEe AREA-5P..n USE ONLY••" <br /> I ( 1 <br /> 713 Records Provided by Staff-PPR Complete- sL-ft K-- <br /> EHo asrb <br /> Received Time All,. 1. 2016 10: 22PM No, 1012 <br />