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j va �1D-0 <br /> Application Processed When Properly Completed.Be Sure To SI Application. <br /> i <br /> APPLICATION FOR INSPECTION <br /> NN"Bi�l(ylEffTRY AND NON-TRANSFERABLE, REVOCABLE,AND SUSPENDABLE SOLID WASTE <br /> /�� cell II.�7l/��1 ENVIRONMENTAL HEALTH PERMIT <br /> SAN JOA OIj+N SOLID WASTE <br /> HEALTH &0-1� h reby m de t c rr on bu ne sunder Permit in the junsdictio of n Joaquin Lo al Health District. <br /> r °��n�epW en Sirs osa service E Eft Grove Florin Rd. #5 <br /> y Business Name(DBA) p Address <br /> ownerEugene & Rose Marie Pinaaco1,Paddress 9467 Sara Street Elk Grove, Calif. 95624 <br /> cc rKU0 <br /> Y Firm Partners,Addresses and Telephone Numbers <br /> a Business Telephone No. 916-685-4061 Emergency Telephone No. 916-685-3264 <br /> j Franchise Area Served Refuse Service Area No. 1 <br /> Applicants Name(Print) Independent Disposal Service Title Corp• Date 11/26/79 <br /> Please check Applicable Category(s).Fill in the Required Information,Return all 3 copies. <br /> ❑ SOLID WASTE DISPOSAL SITE,NO.39-AA- <br /> 11 NEW SITE PERMIT <br /> ❑ SOLID WASTE TRANSFER STATION <br /> ❑ INDUSTRIAL WASTE GENERATOR <br /> ❑ STATIONARY COMPACTOR (20 yd.or greater) <br /> ❑ HAZARDOUS WASTE GENERATOR <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 2--each used <br /> p1 day per wk <br /> 11 COLLECTION TRUCK No.to be permitted eaChpdax 4 hrs <br /> ® ROLL-OFF TRACTOR No.to be permitted 1--on call only—no regular <br /> ❑ ROLL-OFF TRAILER No.to be permitted <br /> customers <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 On call only--no regular <br /> cus tomers-approx 6-12 per <br /> year <br /> I hereby certify that I have prepar his app-CTiAL <br /> nd that to the best of my knowledge it is true and correct. <br /> APPLICANT'S SIGNATURE X ) Title Secretary/Treas. Date 11/26/79 <br /> LttanalA. Thomas <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due: ❑ 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 52.50 $30. 'fir, 3/16/81 Due 4/16/81 $52.50 X <br /> FEE <br /> LESS <br /> PRORATION ?. 'i C- 7' `��% ,4 <br /> PLUS <br /> PENALTY <br /> OTHER <br /> OTHER <br /> Received by D to Receipt No. Permit Nos. Issuance Date Mailed Delivered <br /> APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1601 E.HAZELTON AVE.,P.O.BOX 2009 STOCKTON,CA 95201 <br />