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a 9 <br /> APPLICATION <br /> SAN JOAQUIN COUNTY REFUSE COLLECTOR'S LICENSE <br /> THIS APPLICATION MUST BE ACCOMPANIED BY A CASHIER'S CHECK OR IRREVOCABLE LETTER <br /> OF CREDIT IN THE AMOUNT OF$20,000.(Please print or type.) <br /> 1. Business Name A C 6S O/A$'rC >^ ✓1C'erSj" •Phone <br /> 2. Business Address /F-70( ,6,,cA_V Sr, /,✓E <br /> 0 (Address) (City) (Zip Code) <br /> 3. Owner(s)Name 04vto .22�nGyr,,tft o +ZC, A-m> Phone Ac/fep <br /> Tc�AS5�•�'r-p' , <br /> Home Addresst <br /> (Address) (City) (Zip Code) <br /> 4. County Business License Number ('0 r T% °'-' t e,V r _ g 90/ a p <br /> I hereby certify under penalty of perjury that the above information is true an ect to the best of my knowledge <br /> and belief. <br /> Dated m jf�`7 <br /> GNA RE OF L S E ORA ENT <br /> FOR COUNTY USE ONLY <br /> DEPARTMENT OF PUBLIC WORKS <br /> 1. Received by 4',, r • C ,*,, Date �� ' O S r p <br /> 2. Deposit/Letter of Credit received. [x] Yes [ ] No <br /> 3. Applicant holds current County Business License. [X] Yes [ ] No <br /> 4. Applicant has submitted proof of adequate Workers'Compensation and <br /> Casualty Insurance. [X] Yes [ ] No <br /> 5. Applicant has submitted required financial statement. [X] Yes [ ] No <br /> 6. Revi ereco ended for approval by: <br /> FOR COUNTY USE ONLY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1. Received by _ Date I b� <br /> 2. Applicant has the ability to comply with all applicable County regulations and ordinances and State Law. <br /> (�[X] Yes [ ] No <br /> 3. Reviewed and recommended for approval by: �: ---- <br />