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APPLICATION <br /> 'ftreor Non-Transferable, Revocable, and SuspendaoWif 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 /> F <br /> Business Name(DBA) WONG ENGINEERS, INC. _ Address 4578 FEA_T$EUL RIVER DR_ SUITE <br /> `Owner C. CHANCE WONG Address _ STOCKT -014 CA 95219 <br /> �u Firm Partners, Addresses and Telephone Numbers <br /> Business Telephone No. __ _ 4 7 6-0011 Emergency Telephone No. <br /> Contractor Licence No. <br /> Applicants Name(Print) -.- C. CHANCE WONG _ Title PRES. Date 7-3-92 <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. = PERCOLATION TEST <br /> R.S.or R.C.E. Name C , CHANCE WONG R.S. or R.C.E. No. R.C.E. 14269 <br /> Test Location —_ IO -30 UN_ ROAD Test Date/Time <br /> 4. ❑ SANITATION PERMIT MS-92-104 <br /> Job Address/Location <br /> Owiner Address13 SEPTIC TANK ❑ CESSPOOL ❑ LEACHING 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 — _ _—_ __ Equipment Storage/Cleaning Location(s) <br /> 6. ❑ PACKAGE TREATMENT PLANT For July 1. - June 30, 19 <br /> Opbrator Name -- __ Where Certified <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 /> Homeowner or4censedsrt'sni rinturecertifiesthofe3o�,vino: l'.:'1iL!'.?i•:r�r;c•!'.; rr <br /> e9 9 . rmancecr Je w;;rlT.t;r x'.`_;.U;iS permit+s ass❑ee I snaG rot employ any person <br /> In such manner as in become sao:ect to workman'�corri;rensat+un l;yrs T t i al:rr::•i,. <br /> Contramor's hiring or sub-contracting signahrre certifies the "lowsr.4: : certify that in the performance of the work for which this permit ts Issued.I shall <br /> employ persons subject to workman's compensation laws of Gahtoinia.' <br /> I hereby certify that I have prepared this application and th Ve work will be done in accordance with San Joaquin County <br /> ordinances. state laws, and rules a g s of the S Jo uin Local Health District. <br /> APPLICANT'S SIGNA E - --- <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ January 1 &Received By January 31 ❑ July 1 8 Received By July 31 <br /> REMIT <br /> BILLING REMITTANCE $ <br /> BASE EXPLANATION DATE DATE REMITTED AMOUNT DUE CHECKED <br /> 2_ /J �/] 2 7 _ AMOUNT <br /> FEE ��yt � h cJas 7 l—/ 2 /. /�!/ tis_2- <br /> LESS --- — --- - — - - <br /> PRORATION <br /> PLUS - - -- - - <br /> PENALTY <br /> OTHER <br /> OTHER <br /> Receive— Date Receipt No - Permit No. Issuance Date Mailed Delivered <br /> APPLICANT-RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1601 E.HAZELTON AVE.,P.O.Box 2009 STOCKTON,CA 95201 <br />