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80-525
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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BRADFORD
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2005
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4200/4300 - Liquid Waste/Water Well Permits
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80-525
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Entry Properties
Last modified
7/6/2019 11:08:17 PM
Creation date
12/5/2017 10:27:05 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
80-525
PE
4211
STREET_NUMBER
2005
STREET_NAME
BRADFORD
City
STOCKTON
SITE_LOCATION
2005 BRADFORD
RECEIVED_DATE
08//04/1980
P_LOCATION
MR FAULKNER
Supplemental fields
FilePath
\MIGRATIONS\B\BRADFORD\2005\80-525.PDF
QuestysFileName
80-525 (2)
QuestysRecordID
1667301
QuestysRecordType
12
Tags
EHD - Public
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Applications Will Be Processed When Submitted Properly Completed. Be Sure To Sign The Application <br /> APPLICATION _dl <br /> r (For Non-Transferable,Revocable, and Suspendable) SEPTAGE40000/ <br /> I <br /> ENVIRONMENTAL HEALTH PERMIT <br /> Srf <br /> LIQUID WASTE <br /> Appli ti hereby madeto carry o siness in the jurisdictional area of thn aquin Loc alt rict <br /> rn Business Name (DBA) Address <br /> i Owner Address <br />} a <br /> J Firm Partners, Addresses a elepho umbers <br /> CL Business Telephone No. -' Emergency Telephone No. <br /> a <br /> Contractor Licence No. <br /> L Applicants Name (P Title Date '� 1 <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. License Renewal No, <br /> Capacity Gal.,Weights &Measures'Nd. <br /> Equipment Parking Address a <br /> F. 2. ❑ PUMPER YARD <br /> For July 1, June 30, 19 y� 7 <br /> I x <br /> k No. of Vehicles Stored y <br /> No. of Chemical Toilets Stored - <br /> 3. ❑ PERCOLATION TEST <br /> R.S. or R.C.E. Name _ ,ham :. R.S or R:C_E. No. <br /> Test Location "_ - Test-Date/T mem7. <br /> ` <br /> 4. ❑ SANITATION PERMIT _ _ <br /> Job Addr �Locati n r 00r ! - � LO <br /> Owners//�• iQIJ �Cllf*�-_ {A Address f <br /> 1' ❑ SEPTIC TANK ❑ CESSPOOL i ❑ LEACHING FIELD C7 SffPA E IT `❑❑�,�PA E`PL kNT°�" <br /> © REPAIR ; z r MS OTkFt 1 <br /> 4 �RMANENT ❑ TEMPORARY ; ElNEW-- J , <br /> € 5. © CHEMICAL TOILETS For July 1, `-June 30, 19 <br /> Site <br /> — Disposal <br /> Type Construction .0 P <br /> No. of Units Equipment Storage/Cleaning Locations) P — <br /> t 6. ❑ PACKAGE TREATMENT PLANT For July'-June 30, 19 €,-_' <br /> Operator Name Where-Gerlified <br /> Plant Location 4 <br /> Plant Capacity. -_ -_` _ No. Units Sewed 4 <br /> ^�. <br /> 7.. C1 LAUNDRY For JJuly, 1, -LJune 30'1'9 <br /> i <br /> SIZE: ❑ LesS'Than.1;000 Sq. Ft:,_- 19 More Than 1,000 Sq. Ft. <br /> ❑ DRY CLEANING, Chemicals Used/AmOUnt�Mo. <br /> ,f <br /> - �to <br /> x <br /> 117 <br /> 1 hereby certify that) have r ared this applicatio' t the work wiliYbe_done in accordance with San Joaquin"county < <br /> k ordinances, state laws; an r es o ui L a1 He It istrict. <br /> g <br /> APPLICANT'S SIGNAT i s <br /> FOR DEPARTMENT USE ONLY <br /> Fee IS DUE: ❑ ANNUALLY y ER UNIT PER SITE iF ❑ EACH ❑ a_nuar 1 &Received B_y January 3l ,-:�El JUly 1 &Re1eived By July 31 <br /> REMIT <br /> BASE - EXPLANATION BILLING, - REMITTANCE AMOUNT DUE S CHECKED <br /> - DATE DAZE REMITTED AMOUNT <br /> a <br /> F FEE ` - <br /> c tf ! <br /> PRORATIONLESS <br /> - <br /> PLUS n <br /> PENALTY <br /> OTHER <br /> k OTHER <br /> Received-by - Date - - Receipt No; Permit No. ;� Iss ce ate Mailed elive d - <br /> APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES - 1601 E.HAZELTON AVE.,P.O.Box 2009 -STO TON,CA 2D1.-------L <br />
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