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<br /> "apNr,rtlOns Y,'i! A�a.oCes-jmd when SubmlllPd Properly Compteled, Be Sure To Sign The Application,
<br /> APPLICATION
<br /> ' jFor Non•Trensterable,Revocable,and Suspendabte)
<br /> ENVIRONMENTAL HEALTH PERMIT
<br /> I LIQUID WASTE
<br /> i Appt,critlon if "fN)v m,+!e Irl V'ry On h,a,n'as;in the lurrsdlclional Arra of the San Joaquin Local Heatlr,District
<br /> Business NAmp ORA '
<br /> me,l I ��":: 1t._..c,C`0 I �•�. t ..": 1 /�'r. Address s 1Y�•� e', 4>/�C— 4:ta.C .e C lG' 't ♦ ...
<br /> Owner /- ±-'tG'j. �. -.cam•/ .J_ Address
<br /> Firm Partners, Add•@ssr s and Telepttonr Numt+nrs
<br /> c9usiness Tele ph c,,,,-4 NO S- .J — .3 G' cY Emergoncy Te}ephane NO
<br /> Contractor!icence'io.
<br /> ( Applicants Name(Print) ' r �f . `C�,r/v�j[j`"�' DAte
<br /> Please Check Applicable Category (1-7)and Flit in the Required Information .,•:° !` `
<br /> 1• ❑ PUMPER VEHICLE PERMIT REGISTRATION jrOA EACH VEHICLE)
<br /> Fol JUIy 1. lune�0. T4 Dspossl Sltes ,i..,........iali
<br /> 1
<br /> Description jMake/Yr..Colon
<br /> ' Serirti No ____. CAL. L.Iconse No. CAL,Licarm Renewal No. _
<br /> Capacity riAi,Weights 3 FAea, s No.
<br /> EqutOment Parking Addres ;
<br /> i
<br /> ❑ PUMPER YARD
<br /> �.,
<br /> For Jury 1. Juae 30. 14
<br /> r No.Of Vehiclns wored
<br /> No O1 Chnmicnl Toiler%Slorerf
<br /> -` 1. ❑ PERCOLATION TE„T
<br /> A.S.or R.C.E.Nnrrmn 4.S.or R.C.E.No.
<br /> Test Location w Trst DatplTin+t±
<br /> ;i _ ..._
<br /> 0. XSANITATION PERMIT
<br /> _
<br /> Job Adders /Locl ition r�„ ii.0/�•>:L.-./ � _!. �_ ...._. __..
<br /> Owners-v.�•(_ f ���2 AddressW-
<br /> 7 �TS£PTIC TANK ❑ CESSPOC'L OCO� ACHING FIELD ASEEPAGE PtT 13 PACKAGE PLANT
<br /> PERMANENT ElTEMPORAnY I(NEW ❑ REPAIR ❑ OTHER
<br /> j 5. ❑ CHEMICAL TOILETS rUr,fuar 1. -June 30, 14 ]
<br /> Ty”Construction - Disposal Site
<br /> No of Unit$ Equ•rrnent SSMApr!'Clenni+`p Locallonjsj ? r a
<br /> 1 6. ❑ PACKAGE TREATMENT PLANT For July t, .Jtrne.10. 19
<br /> Ooerator Name Wherry Certified
<br /> t Plant Location
<br /> i
<br /> Pleat Gtpscity_ No U uit SnTVw.1
<br /> f
<br /> T. a L.AUR"►RY Fol July r, - Jurn tri !n 1
<br /> S1[E 0 Less Thnn i ow arl rt, © }.'iT)rn Thhn 1,1104 Frl Ft `'r 1
<br /> ❑ DAY ar-ANING,ChemlcniJ UKnrf/Arrntwt 41r' I
<br /> i k
<br /> _ I hero
<br /> t7y cer0y mine t hnvo p,i,,+nrn4 tits App rirnl,sln nn[f that the Werk wrlf tx! ?nhrt in Accordance with San Joaquin County j
<br /> 9 lydinanCM,Stntn Incas nrtd mleg n',d ifquintlnn-1 at/the SAl.Jo�a�ulr+Local Hnaittt 0191ric1
<br /> APPLICANT'S irCsNATtJT1E x t� � -L. i C C jam+-na .l.•c/c--- �t 4., ,, i ;.'i' �s .��: .� r�nti�iE
<br /> :Cl .,
<br /> r.! ron DEPARI'1MENT VSE ONLY
<br /> 11 OUB:❑ Ati'lI:ALLr' [� i•r ri il•,�• f, r+r II Sltl [❑ 1 Afr! �,] inn..�,t.r 6 R.. Ay J4n„e.V 31 C July i A 71.rf.vM fly Jury 3!
<br /> ' T1ftMlT
<br /> Fratr I arca AKA1lf]N rilli.4Nr: I I Aoumt Our c"tcKro ,
<br /> t•rA:k ❑A!t 'rT.MITTFO AMOUNT f
<br /> 1 ;FSS S
<br /> Pt `l
<br /> It i•1 kA•TV V
<br /> ! Urr.r,n
<br /> C.
<br /> !,.rr,.••.'nt. f,.., e.,.,n,o r r:,; I fruo Mw:lar [Jwr,VArinl
<br /> - Myr''.AM1 •AF TrlRN A'I rq1,•R Yn 4NY,RItMa1 NY Al HI"j T1+r'rnmii,"ayrrr 4 4*0OF #01110M AVF 00.No.20" 1'nci7
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