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ApplicationVf Processed When Properly Completed.Be Sure To Sig r Application. <br /> APPLICATION FOR INSPECTION <br /> NO CARBON NECESSARY AND NON TRANSFERABLE, REVOCABLE,AND SUSPENDABLE SOL11D WASTE <br /> ENVIRONMENTAL HEALTH PERMIT <br /> SOLID WASTE <br /> Application is hereby made to carry on business under Permit in the jurisdiction area of SanJoaquin Local Health District. <br /> H Business Name(DBA) Del to Disposal Service Address 99 W. Sixth, Tracy <br /> i Owner Delta Disposal Service Address P.O. Box 274, Tracy <br /> u Firm Partners,Addresses and Telephone Numbers .\ <br /> ILL 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 /> ❑ SOLID WASTE DISPOSAL SITE,NO.39-AA- <br /> 13 NEW SITE PERMIT J�OP <br /> ATION <br /> 1:1 SOLID <br /> NDUS RIIAL WASTE GEN RT TOR <br /> ❑ STATIONARY COMPACTOR (20 yd.or greater) C\� <br /> ❑ HAZARDOUS WASTE GENERATOR GP't\� +�vp <br /> ❑ INFECTIOUS WASTE GENERATOR PQM\ <br /> ❑ WASTE STORAGE FACILITY <br /> ❑ NEW SITE APPLICATION FEE 1.1 <br /> ❑ MIXED WASTE RECYCLING FACILITY <br /> ❑ MANURE STORAGE SITE ave AUG 2 p 1981 <br /> ❑ SITE EXEMPTION APPLICATION DIST <br /> U1 <br /> VEHICLES AND CONTAINERS(Fill Supplemental Form) $pN 10AQN LOCAL HEALTHMENTAL.HEALTH���' <br /> COMPACTOR TRUCK No.to be permitted 7�Nyw <br /> �m COLLECTION TRUCK No.to be permitted <br /> Ul 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 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 prepay I- Ion d the best of my knowledit is tru d correct. <br /> APPLICANT'S SIGNATU Title 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 2 7/22/81 Due 8/22/81 $100.00 x <br /> FEE ,..."."_=-'s." <br /> LESS <br /> PRORATION _ <br /> PLUS PENALTIES LI) AFTER-DUE 30 DAYS-50 ATE SHOW BELOW <br /> OTHER 60 DAYS-2576 of BASE FEE <br /> OTHER 90 o of BASt ft t <br /> /V <br /> d�lSS 3�� <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 />