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Applications WIII Be Processed When Submitted Properly Completed. Be Sure To Sign The Application. <br /> APPLICATION <br /> .- (For Non-Transferable, Revocable, and Suspendable) <br /> v ENVIRONMENTAL HEALTH PERMIT 5H11AGE _ <br /> LIQUID WASTE <br /> Application is hhereby made to carry on business in the jurisdictional area of the San Joaquin Local Health District <br /> FBusiness Name (DBA) Valley Mechanical Inc. Address P.O. Box 5226, Stockton 95205 <br /> i Owner George J. Fleck Address 0 td, Linden, CA <br /> 4 _ _ <br /> — - <br /> J Firm Partners. Addresses and T ie onNumbers - <br /> CL Business Telephone NO. - 93 - 03 -- Emergency Telephone No. <br /> Contractor Licence NO. 333319 <br /> Applicants Name(Print) ___ Il I�SOOdy Title Dra ,tperson _ Date_ 1/2/81 <br /> e <br /> Please check Applicable Category(1-7)and FIII in the Required information ; <br /> 1. ❑ PUMPER VEHICLE PERMIT REGISTRATION (FOR EACH VEHICLE) <br /> For July 1, -_June 30, 19 — Disposal Sites _ -- <br /> Description(Make/Yr., Color) -_ - <br /> Serial No. - _ _ CAL. License No. _ CAL. License Penewal No. _ <br /> Capacity _ Gal.,Weights & Measures No. - <br /> Equipment Parking Address _ --- <br /> 2. ❑ PUMPER YARD <br /> For July 1, June 30, 19 -No. of Vehicles Stored --No. of Chemical Toilets Stored - -- - <br /> 3. ❑ PERCOLATION TEST <br /> R.S. or R.C.E. Name R.S. or R.C.E. No. <br /> Test Location —_.__ _ Test Date/Time <br /> 4. [;SANITATION PERMIT <br /> Job Address/Location 5950 E. Woodbridge, Aeampo, CA <br /> Owner _Mondavi Winery Address—P,0,aox 427. Woodbridge, CA <br /> M SEPTIC TANK ❑ CESSPOOL_ LEACHING FIELD ❑ SEEPAGE PIT ❑ PACKAGE PLANT <br /> PERMANENT ❑ TEMPORARY KI NEW ❑ REPAIR ❑ OTHER 1 - 1600 gallon tank with (11 <br /> 5. ❑ CHEMICAL TOILETS For July 1. June 30, 19 90' leach line _S) <br /> Type Construction _ Disposal Site -_ _ G1 <br /> No. of Units Equipment Storage/Cleaning Location(s) — 01 <br /> 6. ❑ PACKAGE TREATMENT PLANT For July 1,-June 30, 19 <br /> Where Certified <br /> Operator Name <br /> Plant Location -- <br /> Plant CapacityNo. Units Served <br /> 7. ElLAUNDRY For July 1, -June 30, 19 . _ _ <br /> SIZE ❑ Less Than 1,000 Sq. Ft_ ❑ More Than 1,000 Sq. Ft. <br /> ❑ DRY CLEANING, Chemicals Used/Amount/Mo. - - <br /> eco <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, state laws,ard rV les and plations of the San Joaquin Local Health District. <br /> APPLICANT'S SIGNATURE X _1(SL.G4QC� .. Dr• - <br /> F FOR DEPARTMENT USE ONLY <br /> Fee Is Due: ❑ ANNUAI I.Y ❑ nER UNIT 11 PER SITE ❑ EACH ❑ January 1&Received Ry,laniary 31 ❑ July 1 &Hecewed By J-iy_+ <br /> REMIT <br /> BASE EXPLANATION BILLING REMITTANCE S AMOUNT DUE CHECKED <br /> DA rE DATE REMITTFO AMOUNT <br /> FEE 0445 <br /> LESS <br /> PRORATION _ <br /> PLUS )PENALTY <br /> OTHER � <br /> OTHER i <br /> Recdved by Ua'e Receipt No Permit No. ssuance Date M led Delivered <br /> APPLICANT—RETURN ALL COPIES TO. ENVIRONMENTAL HEALTH PERMIT./SERVICES 1601 E.HAZELTON AYE.. .Boa 2009 STOCKY <br />