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Appllcatlons Will Be Processed When Submitted Properly Completed.as Sure To Sign The Applleallm 1 + <br /> J <br /> _ APPLICATION .� <br /> (For Non-T•ansferable,Revocable,and Suspendable) I <br /> SEPTAGc <br /> ENVIRONMENTAL HEALTH PERMIT <br /> LIQUID WASTE 3� <br /> Application is hereby rnade to carry on hus+noss r,the jurisdictional area of the San Joaquin Local Health Di-ill-^1 <br /> le,%Name(DBA i D• A • 1".4"-Pe/S Ale Address le'l-OX 111,4-V :;7W4/ <br /> — <br /> P, Address _....._-_ .__. • - ---- .. <br /> ParlrCrS.Addresses and"t�TeIrphone N+lmhP•. .._.f._�._.._...-. ---_---- ----•- -- <br /> ness Telephone No. Thi b -7G e 7 Emergency Telephone No. — - ------ <br /> ractor Licence No 4_;ys 3 <br />:_ants Name (Pr.nr Ls+TO l:Jele h Tlue e.Sr/of-47V t Odle -- <br /> se check Appllctble Caterlo-y (1-7)and Ful In the n"ulrec;Information <br /> PUMPER VEHICLE PERMIT REGISThATION (FOR [ACM VEHICLE) <br /> J,iy 1. June 70 19 ^':aI Slt" ---- <br />:ripbon(Make/Yr..Color) <br /> v No CAt- L.cwnS+•No. CAL.Lie~Renewlll No. <br /> deity Gal.We,ghin P. ••,.: ins No ------ <br />;p-nrnt Parking Address <br /> PUMPER YARD <br /> 2dy 1, June 10. 19 <br /> u!Chemical Toilets •rd - --- -- <br /> PERCOLATION 1. aT <br />^r R C E.Name R.S. or R C E.Na <br /> !­v,on Test Cate/Time <br /> SANITATION PERMIT <br /> Location //;I-rib MrCKory Vie.. tF o'D, <br /> 7-.A'•AL1/S A j„rest /0/.1 ft1 V&A /0j,1 , AIrdDRS rw <br />�FPTIC TANK 10kESSPI IOL LA',•• '. FLU Y SEEPAGE PIT ❑ PACKAGE PLANT <br />-`F.PMANENT C TEMPORARY I ":r.'. ❑ REPAIR u OTHER <br />❑ CHEMICAL TOILETS For Joly 1 -it <br /> e Crinatruclion <br /> ,t I,,,,. F,': ,, ', ,•an,n9 I ocahon(s) <br />❑ PAr•KAGE TREATMENT PLANT <br /> rttc+Name Where Certified <br />,t t n'-at+on <br /> it Cahac,ty No Units Served <br />❑ LAUNDRY For July June 30 114 <br /> F ❑ Less Than 1.DM Sq Ft. ❑ 1.1prr Tr, I t <br /> 1W, CLIiAN IG.Chemicals Used'Am,,,lnt Mn <br /> I ner�by cert ty that 1 hake p'PLar P,l " •' a^d that We work wilt be done.n acco dar.'e with San Joaqu,n C/aunly <br /> �rd.nances State laws a^d rubs and r. ^ Aan Joaquin Local Health DM11,0 <br /> +' S SIGNATURE X - <br /> FOR DEPARTMENT USE ONIr <br /> Fr!If DIM' ❑ •%\ •a.'. ❑ +'f: ❑ I A. ❑ .rur.'l Fit r.,...>Mr it.+•. Ir 1•++r 1•F,r..n.►1 lir ur D+ - <br /> wTW <br /> nl Y,r+arr_T t aypVlI PX Cid r;rED <br /> �ZR7F! <br /> •roL+CAWT-I9TVaMA1L•CO►•t5•: •., 4 .v.., . ..Pr aY,T sfavK[S 1M/a HAZalTpfl art.e 0 e..SM eTOC1110al CA Naar <br />