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ot <br /> Applicatio a Processed When Properly Completed.Be Sure To S e Application. <br /> 74 <br /> APPLICATION FOR INSPECTION` <br /> No c� AND NON-TRANSFERABLE, REVOCABLE,AND SUSPENDABLE <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. sg �la„Y <br /> y Business Name(DBA) of Ripon Address "111 14 F1 rst, t, <br /> Owner City of R1000 Address 1 313 W F jrcst, Ripon <br /> Y Firm Partners,Addresses and Telephon Numbers t <br /> COL' Business Telephone No. .-' �� - Emergency Telephone No. <br /> Franchise Area Served Vl' e <br /> L Applicants Name(Print) Title Date <br /> Please check Applicable Category(s).Fill in the Required Information,Return all 3 copies. <br /> 45K <br /> i` ❑ SOLID WASTE DISPOSAL SITE,NO.39-AA- <br />#., ❑ NEW SITE PERMIT r <br /> k: ❑ SOLID WASTE TRANSFER STATION <br /> iw <br /> ❑ INDUSTRIAL WASTE GENERATOR .:- <br /> ❑ STATIONARY COMPACTOR(20 yd.or greater) <br /> ❑ HAZARDOUS WASTE GENERATOR <br /> ❑ INFECTIOUS WASTE GENERATOR <br />' ❑ WASTE STORAGE FACI,kITY <br /> } ❑ NEW SITE APPLICATION FEE <br /> ❑ MIXED WASTE RECYCLING FACILITY � Y' <br /> ❑ MANURE STORAGE SITEpp =, <br /> ❑ SITE EXEMPTION APPLICATION JUL 6 <br />" VEHICLES AND CONTAINERS(Fill Supplemental Form) ENVIRU=J+E!"ITAL HEALTH <br /> ❑ COMPACTOR TRUCK No.to be permitted HRMI /SERVICES <br /> t =_ <br />� ❑ COLLECTION TRUCK No.to be permitted <br /> ❑ ROLL-OFF TRACTOR No.to be permitted ' tr <br /> ❑ ROLL-OFF TRAILER No.to be permitted �x', <br /> (No. to be used dually as Limited Waste Hauler Vehicle) - - - - - - - - - - - - - <br /> RENDERING, <br /> - - - - - - - - - - - -RENDERING,VEHICLE No.to be permitted <br /> ❑ MANUER VEHICLE No.to be permitted a _ <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 thi _ lication andthat to the best of my knowledge it is true and correct. <br /> APPLICANT'S SIGNATURE X 4 Title'*` « Date <br /> - <br /> l.> - r <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 $40.00 81/82 7/9/81 Due 8/9/81 40.00 <br /> FEE <br /> LESS <br /> PRORATION <br /> PLUS <br /> PENALTY <br /> OTHER ` <br /> OTHER <br /> Received by Date Receipt No. Permit Nos. Issuance Date Mailed Delivered <br /> APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1601E HAZELTON AVE.,P O BOX 2009 STOCKTON CA 95201 <br />