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T <br /> SOL,,-, WASTE var.aGcwFN7 BoaRD <br /> N..�A <br /> j1i17' VV�157E FACILITY PERMIT � PLICATION <br /> i n�',,dei rA1.Nr al.LrecY .. ( ll oR t.Nf ORCEM£'NT AGENCY USC ONLY <br /> San Joaquin Local Health District I VILE NUMHEN`l►ERMIT NUMNGR` <br /> San Joaquin Ii DATE RECELVEO FILING FCC <br /> IYr'V OF AI"PLICAnON ..w. I ® <br /> 2. APPLICATION I� DATE ACCEPTED RECEIPT NUMBER <br /> 1 NOTICE OF FOR SOLID WASTE S. APPLICATION FOR MODIFICATION <br /> - OPrRAT1UN • [_] <br /> FACILITY® OF PERMIT f <br /> PERMIT ---- <br /> _ DATE PERMIT ISSUEO CO SWMP REFERENCE PAGE <br /> ♦, AN.ENU ML-NT <br /> APP I_I C AT ION -� 5. A F P L I C A TI O N rOR REVIEW <br /> NOIE: This foirn has been developed for ml,ltlpie uses.. it is the trartsmittal sheet for documents required <br /> to be submitted to the cojoicernent agency. *A Report of Station or Disposal Site Information <br /> or an anlendinent thereto niuSt be submitted with this form. <br /> NAME OF FACILITY-.-. ------�- <br /> - <br /> French Site <br /> - - ---- - <br /> LocnrroN of FwcILIrY eche a • <br /> ADDREcati tocwrtpNDlacRFPTEaN SITsEertcsre TOWNSHIP,RwNaG;eouwsa� - <br /> Section 22 , 'T. 1-N, R6E_ (MD&B) _- <br /> ----- - <br /> r%PE or: FACILITY " <br /> j ------ - <br /> SOLID wA STt DISPOSAL SIT! [ ] T-RANsFEWjPROCESSING SrAIION(,INCLUDES RESOURCE RECOVERY' <br /> (.FNLIIAL 1YP! OF WASTES TO BE RECEIVED _ <br /> 01 5t.1,WI ION I r._� S <br /> t RLS ID F:NT'IaL REFUSG ,_ CUNS7RUC:T IO NJDE MOLITION WASTES M <br /> [� ABA RDO UB WASTES <br /> OF <br /> FACILITY I � CG MM GR CIAL SOLID WASTES �-� SP_WAGE.SLUOCeE � AGRICULTURAL WASTES <br /> JJ <br /> T.-19 LIQUIDS ISLURRCES ..PT.-TANK PUMPING• <br /> i <br /> OTHER _- <br /> ------- �EFFEC•"T PROPOSED CHANGE NECK ONE OR.F+OTN� I CFFECTI VG~ <br /> 11, C•PERAT NN V DATE <br /> IA< ILAf <br /> . .. (I .. (' <br /> INI E?M <br /> l;,11V CC,Nra rNCe:D l._� WILL COMMENCE _I DESIGN OPERATION <br /> .__.-_l__....__. <br /> D <br /> OWNER OF PROPERTY (N <br /> E IApRE®! <br /> City of Stockton ', City Hall , Stockton, CA 95202 <br /> III. OPI:RAT OR JNAMF) -. .. •.�.../ADDRESS <br /> i,!'E{;ATOM <br /> John Giambastiani & Son 1. 1155 W. Mariposa, Stockton, CA 95204 <br /> N'HL.RE LEGAL NOTICL MAY PP !LRVF:D <br /> I City Clerk, City of Stockton, City Hall, Stockton, CA 95202 <br /> - - _ -- - <br /> " FILING FEE EN CLOSED <br /> I hereby acknowledge that I have read this application and the Report of Station or Disposal Site InfolF?a?la- <br /> tion, and certify that the information given is true and accurate to the,best of my knowledge and belief. <br /> In c•pratino the solid waste facility, I agree to comply with the conditions of the permit and with state <br /> iod local enactments. <br /> (",VN'. OR (.I-NTT) <br /> IGNATUR PE AFOR AGENT �,.. <br /> ' ` t <br /> r•. {,i NAMF: TYPED AME <br /> Gerald Dave Phil Giambastiani <br /> . .- _ _ , --- ------- <br /> - <br /> — ---... - - - - - — - <br /> _-. _ _ _-_ _ ._...___._... -_ GATE <br /> �T 17LE I DATE YITLC <br /> CITY MANAGER I partner, JT Giambastiani $ Son l -_:___:______. <br /> 1 CMF CK APPROPRIATE HO}I_ <br /> 'L NI OFCt_N�ENT � - - <br /> t( 1 APPLICATION APPROVCO I ,APPLICATION D1:N!!.D <br /> AGE-NCY l._J _ ..... .. . .. ...... . ....lx `" _._ - •__...-... UAT ND EPHOI.E N .. <br /> r - _.. -. _... ....._.. _ _ -.._.,.. __-... .. <br /> ,. ._-. E.I1 ._.Til O,. <br /> 51vN AT URE TITLE ANDPNINTEU NAME <br /> USE ONLY 1 - <br /> DATE RECEIVED 1 CHr CK APPROPRIATE BOX <br /> SOLID + Lj PR"'U.9EDIPTPI <br /> ERMIT lJ UHIECT TO (__J AGENCY DENIAL UPHELD <br /> iROPUSED ►ERMIT <br /> WASTE <br /> WAN AGENT CNT <br /> OTHER jSPECIFY)__ _ <br /> EO AF D _ .._ <br /> SfINATURE TITLE AND PRINTED NAME DATE AND TELEPHONE NO. <br /> USE ONLY I � ' <br />