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Applications Will Be Processed When Submitted Property Completed. Be Sure To Sign The Application. <br /> _ APPLICATION <br /> (For Non-Transferable. Revocable, and Suspendable) <br /> ENVIRONMENTAL HEALTH PERMIT SF.f TnG= <br /> LIQUIn 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) McDonald Septic Tark Service Address 4645 Hildreth Lane _ <br /> Owner T. R. McDonald Address Same <br /> Y Firm Partners Addresses and Telephone Numbers <br /> IF <br /> Business Telephone No 931-0497 Emergency Telephone No 957-4027 _Q <br /> Contractor Licence No. 308171 <br /> ` Applicants Name (Print) - _T,_-R. McDonald---- - Tine Owner Date _._ V <br /> Please check Applicable Category(1-7)and Fill In the Required Information <br /> 1. ❑ PUMPER VEHICLE PERMIT REGISTRATION(FOR EACH VEHICLE) i <br /> For July 1. June 30 19 Disposal Sites _ <br /> Description IMake!Yr.Color) <br /> Serial No CAL License No CA: .._.-,e P.enewAI 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 R.S.or R.C.E.No _�{ <br /> Test Location Test Date/Time t <br /> 4. ❑ SANITATION PERMIT // r O <br /> Job Address,Loca:.ion/A/ _. �� //�L �-'��fi�i�``�C <br /> Owner _ __- yv/J/_ (id ss <br /> SEPTIC TAN ❑ CESSPOOL LEACHING 40D ❑ SEEPAGE PIT ❑ PACKAGE PLANT j <br /> PERMANENT ❑ TEMPORARY NEW Y� ❑ REPAIR ❑ OTHER <br /> S. ❑ CHEMICAL TOILETS For July 1. -June 30, 19 <br /> Type Construction Disposal Site <br /> No of Units Equipment Storage/Clean inq Location(s) M <br /> 6. ❑ PACKAGE TREATMENT PLANT For July 1. -June 30 19 Q <br /> Operator Name Where Certified ) <br /> Plant Location F <br /> Plant Capacity No Units Served <br /> 7. ❑ LAUNDRY For July 1 -June 30, 19 <br /> SIZF ❑ Lest Than 1 000 Sq Ft, ❑ More Than 1,000 Sq Ft <br /> ❑ DRY CLEANING, Chemicals Used/Amount Mo _ <br /> I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin County <br /> ordinances. statelaws, and ule d roquialions OI V e a <br /> Tn Joaquin Local H to District <br /> APPLICANT SIGNATURE X �- C - <br /> -771 <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due: ❑ AWWAl L r ❑ PER UNIF ❑ PER SITE ❑ EACH Ll Jams.+•y 1 n Receivea Fly January it ❑ July A necel.ed ay July.11 <br /> ... ._ - REMIT .-_---� <br /> BASF F%PLANATION PILLING I REMITTANCE S AMOUNT DUE CHECKED <br /> DATE nATF REMITTED _ AMOUNT <br /> p I --- <br /> FEE LI �- ` t _...�}I 1S <br /> i ESS <br /> PRORATION <br /> PWS <br /> PF14AL TV <br /> OTHER <br /> 1 1 f <br /> OTHER <br /> Q-71(J�o 1'l.� <br /> Fir(O r1 by DRte nnceipl No Forma Nu Issu1 a DRIP MQ'I d (Nrbrered <br /> _— APPLICANT—Rt Tr/ON ALL COP1rt TO ENVIRONMENTAL HEALTH PEIIM1714r RVICEa I001 E HAZELTON AVE.P O ao.717104 4TOCKTON.CI es"I —-- <br /> J <br />