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..ter..-....-.._ ._-.- �� _ .. ___ _._._.. ___....___- ._r_..� -_...r--'--. -� ... .- --a-• ..__ --r r.._____.._ <br /> APPLICATION <br /> (For Non-Transferable, Revocable,and Suspendablel 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 /> L Business-Name('DBA) ENG SEERS Address 15?_.$. FEATHER RIVER. DR. , SUITE -A <br /> dOwner_.. .. ... .__ _ C • C- '.�1C _ ONG_ Address S`rOCKTON� CA. 95219 <br /> Firm Partners, Addresses and Telephone Numbers _._ _....... . <br /> aBusiness Telephone No. �_._.. ..I.7- -QQ _� y. Emergency Telephone No. <br /> 1 Contractor Licence No. - <br /> L Applicants Name (Print)-.__. C* CHANCE WONG Title Date _ 7--20-92 <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 <br /> olor)._---_Serial No. CAL. License No. _- CAL. License Renewal No.�� <br /> Capacity .____ Gal., Weights & Measures No. <br /> Equipment Parking Address <br /> 2. CI 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 YONG R.S. or R.C.E. No- R_-,Cis. 14.269 <br /> Test Location st Date/Time <br /> 4. Z SANITATION PERMIT ROAD MS_92-124 <br /> Job Address/Location <br /> Owner _.._._� _ Address <br /> ❑ 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 .___m _ <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 /> Operator 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 /> NameowrrrLrorf,cnnse3dagant'ystgnetur;aerri#Inalhnfo13awE^rr�rtl'yf"^ll•+ 0erto—alreo'thewortsfor whichthis permitisissued.lshall not employ any person <br /> In SiICI,r'tdr1118t 25 ttl ham.^,Olin[;SL's;:`fn <br /> Contractor's hiring Or 8Ub-C0r1LMC6M1 O tnatllre CBrtiffes I i CS(itS'tl] ,!II:kte t F t�,' d;C3 tlt the work for which this permit is Issued,I shallemploy persons 3ubjeet to wcrk,,, .,a w11;r :,msii .i a..A t j v tltu;.�.u. <br /> I hereby certify that I have prepared this application an%oa <br /> work will be done in accordance with San Joaquin County <br /> ordinances, state laws, and rules ti s of the Sn Local Health District. <br /> APPLICANT'S <br /> `SIG TURE <br /> � - <br /> �p�'/,!�C/'�cl �. "s-!r �i{ ,^1Yr_�^.{,J' � /y�!� '- cJ��/ �="f✓//ice%✓�. / <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ January 1 &Received By January 31 ❑ July 1 &Received By July 31 <br /> _ REMIT — <br /> BILLING REMITTANCE $ <br /> BASE EXPLANATION AMOUNT DUE CHECKED <br /> DATE DATE REMITTED AMOUNT <br /> FEE �O Li_ 2- n� - -] �` _�Z- -21-�iL Z 1 Z•crz, <br /> LESS <br /> PRORATION t <br /> PLUS <br /> PENALTY <br /> OTHER <br /> OTHER ---- --- -- -- <br /> PRecv DateHeCeipt No. Per it 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 />