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Applicatlo Be Processed When Properly Completed.Be Sure To a Application. <br /> APPLICATION FOR INSPECTION <br /> NO CARBON NEC#SSARY AND NON TRANSFERABLE, REVOCABLE,AND SUSPENDABLE SOUD 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 /> yBusiness Name(DBA) Stockton Scavenger Assn.-Transfer St,��M 1240 Navy Drive. Stockton <br /> z Owner Stockton Scavenger Assn, Address 526E (4PbPr AVP-, Stockton 9.52n2 <br /> 2 Firm Partners,Addresses and Telephone Numbers <br /> ILL a Business Telephone No. Emergency Telephone No. <br /> Franchise Area Served <br /> L Applicants Name(Print) Title Date <br /> Please check Applicable Category(s).Fill in the Required Information,Return all 3 copies. <br /> ❑ SOLID WASTE DISPOSAL SITE,NO.39-AA- <br /> 1:1 NEW SITE PERMIT <br /> 12 SOLID WASTE TRANSFER STATION <br /> ❑ INDUSTRIAL WASTE GENERATOR <br /> ❑ STATIONARY COMPACTOR(20 yd.or greater) <br /> ❑ HAZARDOUS WASTE GENERATOR --� <br /> 11 INFECTIOUS WASTE GENERATOR �'� <br /> ❑ WASTE STORAGE FACILITYt � � 1 <br /> ❑ NEW SITE APPLICATION FEE <br /> ❑ MIXED WASTE RECYCLING FACILITY <br /> ❑ MANURE STORAGE SITE <br /> ❑ SITE EXEMPTION APPLICATION ENVIRui1iEKI AL HEALTH <br /> pERMIVSERVICES; <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 is application and that to the.best of my knowledge it is true and correct. <br /> APPLICANT'S SIGNATURE X Title i Date _Q "o <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due: 12 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 $350.00 80/81 7/24/80 8/15/80 $350.00 X <br /> FEE <br /> LESS <br /> PRORATION <br /> PLUS <br /> PENALTY <br /> OTHER <br /> OTHER <br /> Received by Date Receipt No. Permit Nos. Issuance Date Mailed Delivered <br /> APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1801 E.HAZELTON AVE.,P.O.BOX 2009 STOCKTON,CA 95201 <br />