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Applications Will Be Processed When Submitted Properly Completed. Be Sure To Sign The Application. <br /> APPLICATION <br /> (For Non-Transferable, Revocable, and Suspendable) <br /> ENVIRONMENTAL HEALTH PERMIT �SE�AGE <br /> LIQUID WASTE <br /> Application is eby made to carry on business in the jurisdictional area of the San Joaquin Local Health District <br /> ,n Business Name (DBA) I 11ey Mechanical Inc. Address P.O. Box 5126, Stockton 95205 <br /> z owner George J. Fleck Address 0 B��td, Linden, CA <br /> Firm Partners, Addresses and T le hon Numbers <br /> aJ 93 -4031Emer enc Tele hone No. <br /> Business Telephone No. g y p <br /> Contractor Licence No. 333319 <br /> L Applicants Name (Print) Dari Mood <br /> y Title Dra.ftperSori Date 1/2/81 <br /> `. <br /> Please check Applicable Category (1-7) and Fill in the Required Information ; <br /> 1. ❑ PUMPER VEHICLE PERMIT REGISTRATION (FOR EACH VEHICLE) <br /> For July 1, June 30, 19 Disposal Sites <br /> Description(Make/Yr., Color) <br /> Serial No. CAL. License No. CAL. Licc:rse Renewal No. <br /> Capacity Gal.,Weights & Measures No. <br /> Equipment Parking Address <br /> 2. ❑ PUMPER YARD <br /> For July 1, June 30, 19 <br /> No. of Vehicles Stored <br /> No. of Chemical Toilets Stored <br /> 3. ❑ PERCOLATION TEST <br /> R.S. or R.C.E. Name R.S. or R.C.E. No. <br /> Test Location Test Date/Time <br /> 4. IT SANITATION PERMIT <br /> Job Address/Location 5950 E. Woodbridge, Acam o CA <br /> Owner Mondavi Winery Address P.O. Box 42 Woodbridge, <br /> M SEPTIC TANK ❑ CESSPOOL KI LEACHING FIELD ❑ SEEPAGE PIT ❑ PACKAGE PLANT <br /> E3 PERMANENT © TEMPORARY KI NEW ❑ REPAIR ❑ OTHER 1 — 1600 gallon tank With <br /> 5. ❑ CHEMICAL TOILETS For July 1, -June 30, 19 90' leach line <br /> Type Construction Disposal Site <br /> No. of Units Equipment Storage/Cleaning Location(s) <br /> 6. ❑ PACKAGE TREATMENT PLANT For July 1, -June 30, 19 <br /> Where Certified <br /> Operator Name <br /> Plant Location <br /> Plant Capacity No. Units Served <br /> 7. ❑ LAUNDRY For July 1, -June 30, 19 <br /> SIZE: ❑ Less Than 1,000 Sq. Ft., ❑ More Than 1,000 Sq. Ft. <br /> ❑ DRY CLEANING, Chemicals Used/Amount/Mo. <br /> d , <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, state laws, and rr les and r I tions of the San Joaquin Local Health District. <br /> APPLICANT'S SIGNATURE X !'-�'L' - <br /> Oof <br /> FOR DEPARTMENT USE ONLY <br />` Fee Is Due: © ANNUALLY .❑ PER UNIT ❑ PER SITE ❑ EACH ❑ January 5 &Received By January 31 ❑ July l &Received By July 31 <br /> c <br /> REMIT <br /> BASE EXPLANATION BILLING REMITTANCE $ AMOUNT DUE CHECKED <br /> DATE DATE REMITTED �f( � AMOUNT <br /> FEE u�y �"'�"` �cq 5 <br /> LESS IlY <br /> PRORATION <br /> PLUS <br /> PENALTY _ <br /> OTHER ~ <br /> i OTHER <br /> r <br /> Received by Date Receipt No, Permit No. issuance Date M 'led Delivered <br /> APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1601 E.HAZELTON AVE., .Bol 2008 STOCKT <br /> I � � <br />