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Application a Processed When Property Completed.Be Sure To Sig Application. <br /> 1 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 /> F Business Name(Trp4Cy Delta Disposal Service Address Office-1208 Holl Yard-99 W. 6th <br /> Owi+6yac)Pelta Disposal Service Address P• O. Box 274, Tracy, CA 95376 <br /> Firm Partners,Addresses and Telephone Numbers D. Rosaia — C. Repetto — B.M. Roberts <br /> C <br /> Business Telephone No. 835-0601 Emergency Telephone No. 835-0601 <br /> Franchise Area Served 10 <br /> L Applicants Name(Print) 19-M- Roberts Title Partner Date 3/3/80 <br /> Please check Applicable Category(s).Fill in the Required Information,Return all 3 copies. <br /> ❑ SOLID WASTE DISPOSAL SITE,NO.39-AA- <br /> 1:1 NEW SITE PERMIT <br /> ❑ SOLID WASTE TRANSFER STATION An � <br /> 1:1INDUSTRIAL WASTE GENERATOR1:1STATIONARY COMPACTOR(20 yd.or greater) r1:1HAZARDOUS WASTE GENERATOR tt1:1INFECTIOUS WASTE GENERATOR 13 ��' <br /> 7 <br /> ❑ WASTE STORAGE FACILITY SAN r S s� <br /> ❑ NEW SITE APPLICATION FEE I-1EALTH' , L <br /> ❑ MIXED WASTE RECYCLING FACILITY �✓ <br /> 13 MANURE STORAGE SITE ��y <br /> ❑ SITE EXEMPTION APPLICATION Cj� rV" <br /> VEHICLES AND CONTAINERS(Fill Supplemental Form) <br /> EN COMPACTOR TRUCK No.to be permitted — <br /> Q COLLECTION TRUCK No.to be permitted <br /> ® ROLL-OFF TRACTOR No.to be permitted 3 <br /> ❑ ROLL-OFF TRAILER No.to be permitted <br /> (No. to be used dually as Limited Waste Hauler Vehicle) - - - - - - - - - - - - - <br /> 11 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 /> IN 20+YARD BINS,DUMPSTERS,Roll-off&Other Containers No.to be permitted 29 <br /> 1 hereby certify that I have prepar 's applic th t to th�q best of my knowledge it is true and correct. <br /> APPLICANT'S SIGNATURE Title Partner Date 3/3/80 <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 &4 Nih 8-14-80 Due 9-14-8 3O. Oa X <br /> FEE <br /> LESS <br /> PRORATION <br /> PLUS <br /> PENALTY <br /> OTHER <br /> OTHER <br /> d -5,12- a-vn3g8 <br /> 11/16/79 <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 />