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"NM.dppool Applications Will Be Processed When Submitted Properly Completed. Be Sure To Sign rhe Application. <br /> ppncanon. <br /> _ APPLICATION <br /> (For Non-Transferable, Revocable, and SuspendabTe) <br /> ENVIRONMENTAL HEALTH PERMIT S[PTAGF <br /> LIQUID WASTE <br /> Application is hereby made to carry on business in the jurisdictional area of the San Joaquin Local Health District <br /> Business Name(DBA)_ 1YONG ENGINEERS. INC. Address 4578 FEATHER RIVER DR. ,SUITE A <br /> 'itOwner_ C. CHANCE WONG -__ Address STO KTON, CA 95219 <br /> Firm Partners,Addresses and Tel hone Numbers <br /> Business Telephone No. 4T6-0011 _ Emergency Telephone No. <br /> Contractor Licence No. <br /> Applicants Name (Print) - -C . CHANCE WONG <br /> — -- - Title _ PRES. _ pate 7-7-92 <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 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. 0 PERCOLATION TEST <br /> R.S.or R.C.E. Name C CHANE WONG R.S. or R.C.E. No. _ R C 14269 <br /> Test Location -- <br /> Test Date/Time o 42 /S"-/ �/s 4 ____ <br /> 4. El SANITATION PERMIT MS-92-106 <br /> Job Address/Location - <br /> Owner - ___ -_— Address13 SEPTIC SEPTIC TANK ❑ CESSPOOL ❑ LEACHING FIELD ❑ SEEPAGE PIT ❑ PACKAGE PLANT <br /> ❑ PERMANENT ❑ TEMPORARY ❑ NEW ❑ REPAIR ❑ OTHER <br /> S. ❑ CHEMICAL TOILETS For July 1,-June 30, 19-- <br /> Type Construction Disposal Site -No. Of Units -- Equipment Storage/Cleaning Location(s) -- - <br /> 6. ❑ PACKAGE TREATMENT PLANT For July 1, -June 30. 19 --- <br /> operator Name —- Where Certified <br /> Plant Location _ -- - - -- - -- - -- <br /> Plant Capacity - _ No. Units Served <br /> 7. ❑ LAUNDRY For July 1, -June 30, 19 yam. e5T- � � '�0%1 /w'1" <br /> SIZE: ❑ Less Than 1.000 Sq. Ft.. ❑ More Than 1,000 Sq. Ft <br /> ❑ DRY CLEANING, Chemicals Used/Amount/Mo �IC -1_= Vf <br /> ilaelalre►agoU*Waot r' tem*tee r"1 �srwilitAlUisPs/sitisisstred.Ishall neF'mcblan/aer�±a <br /> I:allfOlefrsatisr►tar. +!.a Pert•+.: <br /> yGMEW"aw' M at fws awelfe Ow 'OYrwaw. I cor*1111lW a}be willrmwe of**work tier wfach this perait is isslyd.►sho <br /> tearansiRieh iiwi st CaI,AI>o� <br /> I hereby certify that I have prepared this application an(;l,-tWAT1he work will be done In accordance with San Joaquin County <br /> ordinances, state laws. and rules s of the a uin Local Health District. <br /> APPLICANT'S SIGNATURE X <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ January 1 &Received By January 31 ❑ July 1 &ReceivedREMITuly 31 <br /> ;BASE EXPLANATION BILLING' REMITTANCE s AMOUNT DUE CHECKED <br /> �,( �J DATE DATE REMITTED AMOUNT <br /> FEE G 101 - -- - •_ �� '� <br /> LESS �J <br /> PRORATION -- <br /> PLUS <br /> PENALTY — <br /> OTHER <br /> OTHER Date— Receipt Receipt No PermN No Issuance Date Mailed Delivered <br /> Rect•� ed by OW <br /> 1601 E-HAZELTON AVE.,P.O.Box 2009 STOCKTON,CA <br /> APPLICANT-RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES <br />