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Application Will Be Processed When Properly Completed.Be Sure To Sign Application. <br /> APPLICATION FOR INSPECTION <br /> NO CARBON NECESSARY AND NON-TRANSFERABLE, REVOCABLE,AND SUSPENDABLE SOLID WASTE <br /> ENVIRONMENTAL HEALTH PERMIT <br /> SOLID WASTE <br /> Application is hereby made to carry on business under Permit in the jurisdiction area of San Joaquin Local Health District. <br /> � <br /> Business Name(DBA) <br /> Waste Mana pmant of Califnrnia Address 21-50 F Fremont St , Stockton <br /> w <br /> QOwner Waste Manac1Pmeni- Ins Address P O BOX 9180 Stockton ('A �R?�R <br /> Firm Partners,Addresses and Telephone Numbers <br /> a Business Telephone No. 217191462-0640 Emergency Telephone No. <br /> Franchise Area Served Citi of Stockton <br /> L Applicants Name(Print) Ma-rol Ri5�nn Title C;eneral Manager Date 1-13-89 <br /> Please check Applicable Category(s).Fill in the Required Information,Return all 3 copies. <br /> PAYMENT <br /> ❑ SOLID WASTE DISPOSAL SITE,NO.39-AA- RECEIVED <br /> ❑ NEW SITE PERMIT FEB11 SOLID WASTE TRANSFER STATION B 1 1 9�r4 <br /> ❑ INDUSTRIAL WASTE GENERATOR <br /> r^� <br /> ❑ STATIONARY COMPACTOR(20 yd.or greater) MIRCIVMtiV I AL HEALTH <br /> ❑ HAZARDOUS WASTE GENERATOR PERMIT/SERVICES <br /> ❑ INFECTIOUS WASTE GENERATOR <br /> ❑ WASTE STORAGE FACILITY <br /> ❑ NEW SITE APPLICATION FEE <br /> ❑ MIXED WASTE RECYCLING FACILITY <br /> ❑ MANURE STORAGE SITE <br /> ❑ SITE EXEMPTION APPLICATION <br /> VEHICLES AND CONTAINERS(Fill Supplemental Form) <br /> COMPACTOR TRUCK No.to be permitted 4 <br /> ❑ COLLECTION TRUCK No.to be permitted <br /> ® ROLL-OFF TRACTOR No.to be permitted 5 <br /> ❑ ROLL-OFF TRAILER No.to be permitted <br /> (No. to be used dually as Limited Waste Hauler Vehicle) - - - - - - - - - - - - - <br /> 13 RENDERING,VEHICLE No.to be permitted <br /> ❑ MANUER VEHICLE No.to be permitted <br /> ❑ FERTILIZER VEHICLE No.to be permitted <br /> ❑ LIMITED WASTE HAULER VEHICLE No.to be permitted <br /> ❑ LIMITED WASTE HAULER TRAILER No.to be permitted <br /> ❑ 20+YARD BINS, DUMPSTERS,Roll-off&Other Containers No.to be permitted <br /> I hereby certify that I have prep ed is application an th t to the best of my knowledge it is true and correct. <br /> APPLICANT'S SIGNATURE X Title Date <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ HOURLY ❑ Jan.1&Received By Jan.31 ❑ July 1&Received By,July 31 <br /> REMIT <br /> BASE EXPLANATION BILLING REMITTANCE $ AMOUNT DUE CHECKED <br /> DATE DATE REMITTED AMOUNT <br /> FEE $90.00 9 Units @ 1/5/89 90.00 X <br /> $10 ea <br /> FEE <br /> LESS <br /> PRORATION <br /> PLUS <br /> PENALTY <br /> I ITS Wift BE APPLIED TO PAST DUE ACCOUNTS 30 <br /> OTHER M ` FROM BILLING, <br /> OTHER <br /> Received by Date Receipt No. Permit Nos. 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 />