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h * Applicatlo ocessed When Properly Completed.Be Sure To SI hopiication. <br /> APPLICATION FOR INSPECTION <br /> NO CARBON NECESSARY AND N N TRANSFERABLE, REVOCABLE,AND SU ' ENDABLE 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 /> F Business Name(DBA) Johns-Manville Corp. Address Sperry & Airport Rd. , Stockton <br /> Owner Johns-Manville Corp. Address P.O. Box 1587, Stockton 95201 <br /> L) Firm Partners,Addresses and Telephone Nu bers <br /> COL' Business Telephone No. � _V",� � Emergency Telephone No. <br /> ly <br /> Franchise Area Served <br /> L Applicants Name(Print) Y� lATitle to <br /> Please check Applicable Category(s).FIII in the Required Information,Re( atopies. 0,C)ir� <br /> d <br /> XnXSOLID WASTE DISPOSAL SITE,NO.39-AA- 013 CO <br /> ❑ NEW SITE PERMIT 7,D <br /> 0 SOLID WASTE TRANSFER <br /> 11INDUSTRIIAL WASTE GENRATORN IDt(� � <br /> ❑ STATIONARY COMPACTOR(20 yd.or greater) <br /> JULJg�F� <br /> ❑ HAZARDOUS WASTE GENERATOR <br /> ❑ INFECTIOUS WASTE GENERATOR SAEN��Q��IAL HEALTH DIV.T. <br /> ❑ WASTE STORAGE FACILITY <br /> ❑ NEW SITE APPLICATION FEE �. Ikvb <br /> ❑ MIXED WASTE RECYCLING FACILITY <br /> ❑ MANURE STORAGE SITE <br /> , o <br /> ❑ SITE EXEMPTION APPLICATION <br /> VEHICLES AND CONTAINERS(Fill Supplemental Form) y <br /> ❑ COMPACTOR TRUCK No.to be permitted <br /> ❑ COLLECTION TRUCK No.to be permitted <br /> ❑ ROLL-OFF TRACTOR No.to be permitted <br /> ❑ ROLL-OFF TRAILER No.to be permitted <br /> (No. to be used dually as Limited Waste Hauler Vehicle) - - - - - - - - - - - - - <br /> ❑ 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 prepared this applicatio n hat the best of my knowledge it is true and correct. <br /> APPLICANT'S SIGNATURE X Title Date <br /> loe <br /> �/ <br /> FOR DEPARTMENT USE ONLY ��y{c.,, <br /> Fee Is Dusk ANNUALLY ❑ PER UNIT 11 PER SITE 1-1EACH 13 HOURLY 1-1 Jan.1&Received By Jan.31 KX.ly 1&Received By July 31 <br /> REMIT <br /> BASE EXPLANATION BILLING REMITTANCE $ AMOUNT DUE CHECKED <br /> DATE DATE REMITTED AMOUNT <br /> FEE $500.00 81/82 7-1-81 Due 7-31-E1 $500.00 X <br /> FEE <br /> LESS <br /> PRORATION <br /> PLUS ALTIES WILL BE ADDED AFTER DUE <br /> PENALTY DATE SHOWNI R;l ns,—. <br /> 30 DAYS O O <br /> OTHER 60 DAYS <br /> OTHER 90 DAYS 25% of BASE FEE <br /> m � -7I�dl� � � ��� �� 3 � -��s��� 2 r/ / <br /> Received by Date Receipt No. Permit Nos. Issuance D& Mailed Delivered <br /> APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1601 E.HAZELTON AVE.,P.O.BOX 2009 STOCKTON,CA 95201 <br />