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k. <br /> Applicata Will Be Processed When Properly Completed.Be Sunt To The Application. <br /> APPLICATION FOR INSPECTION <br /> NO CARBON NECESSARY AND NON-TRANSFERABLE, REVOCABLE,AND SUSPENDABLE SOLID WASTE <br /> ENVIRONMENTAL HEALTH PERMIT <br /> SOLID WASTE <br /> Application is hereby made to carry on business under Permit in the jurisdiction area of San Joaquin Local Health District. <br /> yBusiness Name(DBA) Stnrkton Scavenger Assn- Address 1140 N E1 Dorado, Stockton <br /> ` Owner Stockton Scavenger Asso Address 1140 NV F1—Daradn, Stockton <br /> j Firm Partners,Addresses and Telephone Numbers <br /> a Business Telephone No. Emergency Telephone No. <br /> Franchise Area Served <br /> L Applicants Name(Print) Title Date <br /> Please check Applicable Category(s).Fill In the Required Information,Return all 3 copies. <br /> O <br /> ❑ SOLID WASTE DISPOSAL SITE,NO.39-AA- S�Q <br /> ❑ NEW SITE PERMIT <br /> ❑ SOLID WASTE TRANSFER STATION ® / <br /> ❑ INDUSTRIAL WASTE GENERATOR f <br /> ❑ STATIONARY COMPACTOR(20 yd.or greater) F <br /> ❑ HAZARDOUS WASTE GENERATOR <br /> ❑ INFECTIOUS WASTE GENERATOR �����✓ G <br /> ❑ WASTE STORAGE FACILITY w` <br /> ❑ NEW SITE APPLICATION FEE <br /> ❑ MIXED WASTE RECYCLING FACILITY �a� <br /> ❑ MANURE STORAGE SITE <br /> ❑ SITE EXEMPTION APPLICATION <br /> VEHICLES AND CONTAINERS(Fill Supplemental Form) <br /> QQ RAr=W T U6K No.to be permitted 32 <br /> ❑ COLLECTION TRUCK No.to be permitted <br /> RO - I89,TOR - No.to be permitted 12 <br /> —17 ROLL-OFF TRAILER No.to be permitted <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 <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 tiff e,E 1 A-CE'S a Date <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 $440,00 81/82 7/14/81 Due 8/14/81 $440.00 X <br /> FEE <br /> LESS t <br /> PRORATION <br /> PLUS PENALTIES WILL BE ADD D AFTER DUE DAfi <br /> PENALTY <br /> f BAS: Fft <br /> OTHER C O Ot <br /> OTHER 90-DAYS 25-(Y. Of 14 gE <br /> 1(v/1 9 V9� M33q7 _M38­':�� <br /> Received by Date Receipt No. Permit Nos. Issuance Date Mailedd Delivered <br /> APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1601 E.HAZELTON AVE.,P.O.BOX 2009 STOCKTON,CA 95201 <br />