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Application a Processed When Properly Completed.Be Sure To SI a Application. <br /> 41 V <br /> APPLICATION FOR INSPECTION "j l "" I <br /> NO CARBON NECESSARY AND NON-TRANSFERABLE, REVOCABLE,AND SUSPENDABLE SOLID WASTE <br /> Lb <br /> ENVIRONMENTAL HEALTH PERMIT " " 19 1981 <br /> SOLID WASTE <br /> Application is hereby made to carry on business under Perm' I the 14risdiction area of San Joaquin Local Health District' 0, <br /> y Business Name(DBA) ijs pi)rUnri ty�i,f, hb�i('o- a�ASS P. O. BOX 447 <br /> Owner San Joaquin Co. Housing AiathontV Address 136 Chung Wah Lane, Stockt-nn 952Q2 <br /> J Firm Partners,Addresses and Telephone Numbers <br /> COL' Business Telephone No. 466-5051 " Emergency Telephone No. 466-0216 <br /> Franchise Area Served <br /> L Applicants Name(Print) OagTiittlle-b�l�i�P3''�i ed Date 12-7-79 <br /> Please check Applicable Category(s).Fill In the Required Information, urn all 3 Copies. Administrator of Maintenance <br /> ❑ SOLID WASTE DISPOSAL SITE,NO.39-AA- <br /> NEW SITE PERMIT <br /> ❑ SOLID WASTE TRANSFER STATION I\ <br /> ❑ INDUSTRIAL WASTE GENERATOR CEIVED <br /> STATIONARY COMPACTOR (20 yd.or greater)E3HAZARDOUS WASTE GENERATOR <br /> ❑ INFECTIOUS WASTE GENERATOR <br /> 13 WASTE 10 1901 <br /> WASTE STORAGE FACILITY y <br /> ❑ NEW SITE APPLICATION FEE <br /> ❑ MIXED WASTE RECYCLING FACILITY HOUSING AUTHORITY <br /> ❑ MANURE STORAGE SITEQ r:a� OF THE COUNTY <br /> 1-1SITEEXEMPTION APPLICATION t�Q OF SAN JOAQUIN <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, <br /> - - - - - - - - - - - - <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 TR 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 this application and that to the best of my knowledge it is true and correct. <br /> APPLICANT'S SIGNATURE X Title AcIninistrator of Date 12-7-79 <br /> �l Maintenance <br /> �' l 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 C/� �rAMOUNT <br /> FEE $17. Rn KIM 31191/81 . 4/9/81 37.50 X <br /> FEE <br /> LESS <br /> PRORATION <br /> PLUS <br /> PENALTY <br /> OTHER <br /> OTHER II <br /> 3 w I �� /O f - 11/16/79 <br /> Received by hate 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 />