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Application a Processed When Properly Completed.Be Sure To SI Application. <br /> APPLICATION FOR INSPECTION <br /> NO CARBON NECESSAR"v AND NON-TRANSFERABLE, REVOCABLE,AND SUSPENDABLE <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 /> H Business Name DBA) Stockton Scavenger Assoc. Address 1240 Navy DRi ve, Stockton <br /> i Owner Stockton Scavenger Assoc. Address 1140 N. E1 Dorado St. , Stot:kton <br /> Firm Partners,Addresses and Telephone Numbers <br /> Business Telephone No. Emergency Telephone No. <br /> Franchise Area Served <br /> L Applicants Name(Print) Title <br /> Please check Applicable Category(s).Fill in the Required Information,Return all 3 copies. D <br /> ❑ SOLID WASTE DISPOSAL SITE,NO.39-AA- <br /> ❑ NEW SITE PERMIT <br /> XU SOLID WASTE TRANSFER STATION <br /> ❑ INDUSTRIAL WASTE GENERATOR SP►N I�P+QU�N`a1PL NEp1-�� 1j <br /> ❑ STATIONARY COMPACTOR(20 yd.or greater) ENV�R�NMEN a <br /> ❑ HAZARDOUS WASTE GENERATOR Q ' <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 <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 application and that to the best of my knowledge it is true and correct. <br /> APPLICANT'S SIGNATURE X .---, - Title VICE AR45SI.0E�VT Date 77 6 <br /> FOR DEPARTMENT USE ONLY y,yy�{yy� <br /> Fee Is Due-M&NNUALLY 1:1 PER UNIT ❑ PER SITE 11 EACH 11 HOURLY 11 Jan.1&Received By Jan.31 XlgAluly 1&Received By July 31 <br /> REMIT <br /> BASE EXPLANATIONBILLING REMITTANCE $ AMOUNT DUE CHECKED <br /> DATE 5 DATE REMITTED AMOUNT <br /> FEE $350.00 81/82 7-1-81 Due 7-31-Ell $350.00 X <br /> FEE <br /> LESS <br /> PRORATION <br /> PLUS PENALTIES MILL BE ADDEC AFTER DUE DATE SHOWN BELOW <br /> PENALTY <br /> ,30 DAYS- /O <br /> - of BASE FEE <br /> OTHER 60 DAYS- 255. of BASF IEEE <br /> OT-HER 90 DAYS-25% of BASE EE <br /> rrn 5t- -7 / -72T 1 i <br /> Received by Date Receipt No. Permit Nos. Issuance.Date Mailed Delivered <br /> APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1991 E.HAZELTON AVE.,P.O.BOX 2009 STOCKTON,CA 95201 <br /> I <br />