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- AppllcatloBe Processed When Properly Completed.Be Sure To S e Application. <br /> 0 <br /> APPLICATION FOR INSPECTION iv <br /> NO CARBON NECESSARY AND NON-TRANSFERABLE, REVOCABLE,AND SLISPENDABLE SOLID WASTE <br /> ENVIRONMENTAL HEALTH PERMIT <br /> SOLID WASTE <br /> Applicatiun is herebv.made toparry on business under permit in the jurisdictiop Area of_$Rn Jaouin Local Hpalth Di�rjct. <br /> rBusiness Name(DBA)__�elta Container jJO.rOri Ar!*+rPss P Box 6 -St�CkQ �__5;�-� _ Q�= <br /> < <br /> Owner (Site Owner) Fred WittL Address 55 W�-' 61,1,erson Rd.. StQ.ottlo.A,2.0 _ 9 200 <br /> J <br /> Firm Partners,Addresses and Tele hone Numbers N/A 3 <br /> 'ILL Business Telephone No. 466-5192 Emergency Telephone No. 943-2960 Or 478-8183 <br /> Franchise Area Served <br /> � <br /> ApplicantsName(Print) Gregory J. Basso Title Vice President Date' June 1980 <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 D <br /> 11 INDUSTRIAL 3� a0p / S INDUSTRIAL WASTE GENERATOR <br /> ❑ STATIONARY COMPACTOR(20 yd.or greater) 6D _4 CztPtllz,^ <br /> ❑ HAZARDOUS WASTE GENERATOR SPr• �� + d 1,s c-'❑ INFECTIOUS WASTE GENERATOR 1 <br /> ❑ WASTE STORAGE FACILITY 114 <br /> ✓?��/ WrGj 5T t' d <br /> ❑ NEW SITE APPLICATION FEE <br /> 1 ❑ MIXED WASTE RECYCLING FACILITY �25 AA4GCItS2,,,A lQZ,5&i,- <br /> ❑ MANURE STORAGE SITE (25,q- 4)t)_q-0 <br /> SITE EXEMPTION APPLICATION 2- d L� <br /> `r gds,-2�2.,rS <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 /> 13 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 prepare hi application and t at to he best o my knowledge it is true and correct. <br /> APPLICANT'S SIGNATURE X Vice President Date 4 June 1980 <br /> Grego 0 <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 /> 4 DATE DATE REMITTED AMOUNT <br /> FEE .f)fi ( � `/4C <br /> FEE ►►►►TTTT <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 1601 E.HAZELTON AVE.,P.O.BOX 2009 STOCKTON,CA 95201 <br />