Laserfiche WebLink
0 za4i II do *sed When Properly Completed.Be Sure To Sig Application. <br /> APPLICATION FOR INSPECTION <br /> NO CARBON NECESSAR7UN 2kW!� N-TRANSFERABLE, REVOCABLE,AND SUSPENDABLE SOLID WASTE <br /> ENVIRONMENTAL HEALTH PERMIT <br /> SAN il,�iyQIJIN W- ''AL SOLID WASTE <br /> O,f4 ' DISTRICT <br /> Applicat o s ereby made to carry on business under Permit in the jurisdiction area of San Joaquin Local Health District. <br /> y Business Name(DBA) Airport Garbage Address 1722 Mono Drive, Modiagto <br /> i Owner Address <br /> a <br /> J Firm Partners,Addresses and Telephone Numbers <br /> aBusiness Telephone No. �©9,� --a 7—^' Emergency Telephone No. <br /> Franchise Area Served <br /> L Applicants Name(Print) urr e,Jt� i ROy G1�✓oA✓ Title p&� T/y �' 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 /> 11 NEW SITE PERMIT <br /> ❑ SOLID WASTE TRANSFER STATION <br /> ❑ INDUSTRIAL WASTE GENERATOR f <br /> ❑ STATIONARY COMPACTOR(20 yd.or greater) <br /> ❑ HAZARDOUS WASTE GENERATOR <br /> ❑ INFECTIOUS WASTE GENERATOR °7 <br /> ❑ WASTE STORAGE FACILITY JUL 2 7 19a� <br /> 1:1 NEW SITE APPLICATION FEE / <br /> ❑ MIXED WASTE RECYCLING FACILITY SAN JOAQUIN LOCAL HEALTH <br /> ST. <br /> 11MANURE STORAGE SITE ENVIRONMENIV <br /> ENVIRONMENTAL HEALTH D <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 /> 0 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 th' application and that to the besl of my knowledge i is true and correct. f� <br /> APPLICANT'S SIGNATURE X Title Date a <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due:X❑ ANNUALLY ❑ PER UNIT ❑ PER SITE W EACH ❑ HOURLY ❑ Jan.1&Received By Jan.31 q July 1&Received By July 31 <br /> REMIT <br /> BASE EXPLANATION BILLING REMITTANCE $ AMOUNT DUE CHECKED <br /> DATE DATE REMITTED AMOUNT <br /> FEE $10, ea 3 veh. 7-1-81 Due 7-31-81. $30.00 X <br /> FEE <br /> LESS <br /> PRORATION <br /> PLUS <br /> PENALTY <br /> OTHER <br /> OTHER <br /> Received by IDate Receipt No. Permit Nos. Issuance Date Mailed Delivered <br /> APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1001 E.HAZELTON AVE.,P.O.BOX 2009 STOCKTON,CA 95201 <br />