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110Plications Will Be Processed When Submitted Properly Completed. Be Sure To Sign The Application. <br /> .7J APPLICATION <br /> ( on-Transferable, Revocable,and Suspendable)* SEPTAGE <br /> ENVIRONMENTAL HEALTH PERMIT <br /> , -;, ' LIQUID WASTE <br /> Application is hereby made to carry on business in the jurisdictional area of the San Joaquin Local Health District <br /> H Business Name (DBA) Valley Mechanical Inc. Address P.O. Box 5126 Stockton, Calif. 95205 <br /> a Owner San Joaquin County Address 222E Weber Room 691 Stockton,_Calif, 95202 <br /> Firm Partners, Addresses and Telephone Numbers P.O. Box 5126 Stockton, Calif.' 95205 (209) 931-4031 <br /> a Business Telephone No. (209) 931-4031 Emergency Telephone No: (209) 931-4031 <br /> Contractor Licence No. 333319 <br /> L Applicants Name (Print) Jim Haley Title Estimator Date 8/18/82 <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 'V <br /> Description(Make/Yr.,Color) <br /> Se 'al yo, CAL. License No. - CAL. License Renewal No. <br /> C aclty ' Gat.,Weights&Measu>es fJo` <br /> 3 <br /> Equipmen�)'e�ing=Address � ' <br /> 2. ❑ PUMPER YARD <br /> For July 1, June 30, 19 r <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. rt <br /> Test Location Test Date/Time <br /> 4. 19 SANITATION PERMIT <br /> Job Address/Location 7.5 miles South of HiQhwav�l?D on irport Road s <br /> Owner San Joaquin County Address 222 E. Weber Room 691 Stockton, Calif. 95202 <br /> 0 SEPTIC TANK ❑ CESSP66L`$ B'LEACRA4 FIELD+ ❑ SEEPAGE PIT ❑ PACKAGE PLANT <br /> ❑ PERMANENT ❑ TEMPORARY © NEW ❑ REPAIR ❑ OTHER <br /> 5. ❑ CHEMICAL TOILETS .;For July 1, -June 30, 19 <br /> Type Construction ' * `- Disposal Site <br /> No. of Units Equipmrei%Stor,age/Cleaning Locations) <br /> 6. ❑ PACKAGE TREATMENT PLANT For July 1, -June 30, 19 <br /> Operator Name Where Certified <br /> .r <br /> Plant Location <br /> Plant Capacity No. Units Served <br /> 7. ❑ LAUNDRY` �r July 1j-June 30, 19 , <br /> SIZE: ❑ Less Than.1,000 Sq. Ft., ❑ More Than 1,000 Sq. Ft. <br /> ❑ DJRY CLEANING,Chemicals Used/Amount/Mo. <br /> Home owner orlicensed a ent'ssignaturecertifiesthefciiowing icertify �aiii!heperfori-nince of thevicirk,forwhich this permit is issued,I shall not employ any person <br /> in such manner as to becomi sgblect to workinan s compensat.on laws.,1(ai,fcri,:U. <br /> Contractor's hiring or sub-contracting signature certifies the follow a •'t cPt !:tat,r the perlvioiamc-of the work forwhich this permit is issued,I shall <br /> employ persons subject to workman's compensation laws of <br /> I hereby certify that II <br /> prepared is application and that the work will'be done in accordance with San Joaquin County- <br /> ordinances, state law ules a gu o s the San Joaquin►,Lgcal Health District. <br /> APPLICANT'S SIGNATURE X <br /> Z <br /> FOR DEPARTMENT USE ONLY (�4C�st Q 13 <br /> Fee Is DUAL ❑ ANNUALLY N-13,PER UNIT ❑ PER SITE` -❑ EACH ❑ January &Peceived By January 31 ❑ July 1 &Received By July 31 <br /> REMIT <br /> BASE EXPLANATION <br /> BILLING REMITTANCE $ <br /> D E DATE REMITTED AMOUNT DUE CHECKED <br />- AMOUNT <br /> FEE - <br /> LESS <br /> PRORATION <br /> PLUS , - i. } f <br /> PENALTY f r <br /> OTHER <br /> OTHER <br /> Received by Date Receipt No. Permit o. Is u n a Mailed Delivered <br /> APPLICANT—RETURN ALL COPIES TO ENVIRONMENTAL HEALTH PERMIT/SERVICES 1804 E.HA2E4 NAVE.,P.O.Box 2009 STOCKTON,CA 95201 <br />