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d Property <br /> Applications Will Be Processed When SubAPtteeLICATIONpelea. o� Jy ` •_ . <br /> `[ra/Non-Transferable, Revocable,and Suspendable)./ SEPTAGE <br /> ENVIRONMENTAL HEALTH PERMIT <br /> LIQUID WASTE <br /> Application is hereby made to carry on business in the jurisdictional area of the 4645 Hildret n Joaquin Local Health <br /> lLn (strict <br /> 3uslness %_-e IDEA) McDonald Seotic Tank Service address Stockton, Ca 95212 <br /> owner T. R. McDonald Address <br /> 9rm Pa^.re.. Addresses and Telephone Numbers Emergency Telephone No. 957-4027 <br /> 3usiness Ti aphone No. 931- enc 0497 9 y <br /> ;ontractor L cence No. 308171 Title Owner <br /> TR. McDonald Title Date <br /> T.>pplica^•s`•ame (Print) - <br /> 'lease check Applicable Category (1-7) and Fill in the Required Information <br /> 1. ❑ PUMPER VEHICLE PERMIT REGISTRATION (FOR EACH VEHICLE) <br /> =or Jury '. June 30, 19 Disposal Sites <br /> Descrip Make/Yr., Color) CAL.Ucc-se Renewal No. <br /> aerial N- CAL. License No. <br /> Capacity Gal.,Weights &Measures No. <br /> quipme-: 'arking Address <br /> 2. ❑ PUMPER YARD <br /> =or July'. June 30, 19 <br /> Vo. of Ve- =es Stored <br /> No. of C^_cal Toilets Stored <br /> 3. ❑ PERCOLATION TEST <br /> R.S. or R.C.E.No. <br /> R.S. or R.C.E. Name <br /> Test Lcca: = Test Date/Time / <br /> 4. ❑ SANITATION PERMIT �( ,/ <br /> Job A -. .-:_ Locations <br /> Owner -� '+1/A Address 13 PACKAGE PLANT <br /> �.SEP C -.ANK ❑ CESSPOOL �CLEACHING FIELD 11 SEEPAGE PIT 13OTHER <br /> C1PER A-.ENT ❑ TEMPORARY ANEW ❑ REPAIR <br /> 5. ❑ CHEMICAL TOILETS For July 1,-June 30, 19 <br /> Type Co^s:-.cation Disposal Site <br /> No. of U- Equipment Storage/Cleaning Location(s) <br /> 6. ❑ PACKAGE TREATMENT PLANT For July 1,-June 30, 19 <br /> Where Certified <br /> Operator Name <br /> Plant Lcca:on <br /> Plant Cao=_cry 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 /> I <br /> the <br /> - y i <br /> 1 hereby certify that I have prepared this appiicatib n tat the work will be done in accordance witl]iSarJDuin'County— <br /> ordinances, state laws, and r as and regul ' ns of the San Jo uin Local HealthDii*qp,l\ z,4 <br /> APPLICAN-S SIGNATURE X Q, <br /> FOR DEPARTMENT USE ONLY (` <br /> Fee Is Due: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ January 1 8 Received By0 nuary 31 my Receive R I July 31 <br /> BASE EXPLANATION BILLING REMITTANCE 5�- T DUE CKED <br /> GATE DATE REMI AMOUNT <br />