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App'icsltons Will Be Processed When Submit/ed Property Completed.Be Sure To Sian The Application. <br /> APPLICATION <br /> (For Non•Tronsfamble,Royoeable,and Suspendable) <br /> ENVIRONMENTAL HEALTH PERMIT <br /> LIQUID WASTE <br /> 4ppliGa:On Is hem�pl(^/�{ 1I r O U mq theu�yyy�C�UOn area OI Inn+g��nCJ�dpwn L.UC11 M dl h DIIInCi `1 <br /> M Business Name(DBA) ��E Y�j E"�L ��� f"k- \ ddres! �].+ Q W ��R� <br /> Owner Lf- F— W fkit Address <br /> Y Firm Partners.Address"en ylhg Numpera <br /> Business Telephone No. '�]`1 Emerj•Rcy Telephone No <br /> y Contractor Licence No. S � L� a+1- `` - <br /> L Applicants Name(Prinl) �E '_. �`Z�`' L� _ Title C:.JN YR .to"to <br /> PMe check Applicable Category(/-7)and FIR In ole Required Inlonvuldon <br /> 1. O PUMPER VEHICLE PERMIT REGISTRATION(FOR EACH VEHICLE) <br /> For July t,__.- June 30. 19 Dis""I Sites <br /> Description(MoketYr.,Color) <br /> Serial Ho. ._ __. __ . CAL. License No. _.._..._. _ _ CAL.Lkertse RenasseI ND._ <br /> Capacity-- GRI..Weights A Measures No. <br /> .i Equipment Parking Address <br /> 2 CI PUMPER YARD <br /> For July 1,_�. June 30. 19 <br /> -I No.of Vehicles Stored <br /> No.W Chemical Todels Stored ' <br /> 3. O PERCOLATION TEST <br /> lit <br /> R.S.or R.C.E.Name R.S.or R.C.E.No. <br /> Test Location _ _._ _ _ _ Teal D&WTime--_.___. ._____._ <br /> a. ❑ SANITATION Pgpmfy y <br /> 9 'its <br /> J nAddreM/Locallpn ER O _CIi'C�Et�C�E�'.._R,D' Yrol.Ll0�1�rC. So <br /> Add <br /> gSE�PTIC TANK 0 CESSPOOL fNEW <br /> ACHING FIELD SEEPAGE PIT U PACKAGE PLANT (� <br /> PERMANENT O TEMPOTIARY REP" OTHER <br /> S. CHEMICAL TOILETS For July 1.• 0, 19 _-- <br /> 1Jf .YPO construction_.__— _ Disposal site <br /> No.OI Unita Equipment StomgWClsanMg Location(@) — t <br /> S. O PACKAGE TREATMENT PLANT For July 1,•June 30,19 <br /> Operator Nemo _ _. _ - _.... - Wh"Cer1NN0 <br /> Plant Loceliml <br /> Plant Capacity__. .__._ ._ No.Units Served_ _ [ <br /> T. O LAUNDRY For July 1,-June 30. 19_____ #4 <br /> S'ZE: O Less Than 1,000 Sq.Ft., Cl More Than 1,000 Sq.Ft <br /> ❑ DRY CLEANING,Chemicals Used/AmounVMo. ... <br /> �,. unspent ,n..-....n...�.r..,•.+,....,...Nr..�.. n <br /> - -T.n� "1''•" "L••`•'^^rr•5!Srrrr'rkfntfpxlMNbInN.IM@01M' , aytnyerrsa <br /> �, , ':++•1.. .. ,.cal to Lm.,. . . .. _ .. 2n!.,f!h Nqk ler STNC111MS^ 1 <br /> 1 hereby certify hW1ve prepared 1 Rpplicati end that the work will be done In accordance with Sen Joaquin County <br /> ordinances,state laws,e1 d r rid la i s 1 s Sa oequl I Health District. <br /> APPLICANT Z19NAT14` <br /> FOR DEPARTMENT USE ONLY <br /> FN It Dua:❑ ANNUALLY Q PER UNIT 0 PER SITE EACH 0 Jarwary 1 a neCalrad By JamM131 Q jury 1 a Are PHI M J,tiv 2, <br /> BILLING nEMTTANO <br /> IA L REMIT <br /> _ T <br /> BASE Ea0.ANAT10N CATE I �wmme AapUNy CAPE CHECKED <br /> ppLu�Cox <br /> AMOUNT <br /> EE! —__ W_I -. ..__._ - _ R - <br /> PR98 <br /> 1AT10N 9 '/-6i - -/iF. <br /> PLUS -' - <br /> PENALTY <br /> OTHER <br /> OTHER <br /> KarMHU 4Y UIIIe IM[Mpl Nn IIerT11�I )EMMnLeTfaN IM (Mii.wrW - <br /> APM IGAMT—RETUIIN ALL COPIES TO LNVIRONMEMAL HEALTH PERMITISINVIC12 Nal f.HAMILTON Aye. •21301 STOCKTON.CA HNr <br />