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i <br /> Applicatlo I Be Processed When Properly Completed.Be Sure #SSPEENDABLER <br /> e Application.4 <br /> APPLICATION FOR INSPECTIO NO CARBON NECESSARY AND N RANSFERABLE,.REVOCABLE,ANDSOLID WAST <br /> ENVIRONMENTAL HEALTH PERMITS AUG 5 1 <br /> ®"d - SOLID WAS �. 1981 <br /> Application is hereby made to carry on business under Permit in the jurisdiction area of San Joaquin Locc�ll�ry t le Wf.V <br /> y Business Name(DBA) San Joaquin County -Lovelace Rd. Address Love l ace Rd. Mar <br /> iOwner San ,1oaT►in County Address 1810 E. Hazelton, Stockton T <br /> J Firm Partners,Addresses and Telephone Numbers <br /> 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 /> ❑ NEW SITE PERMIT Y`'S <br /> ❑ SOLID WASTE TRANSFER STATION <br /> ❑ INDUSTRIAL WASTE GENERATOR1:1 STATIONARY COMPACTOR(20 yd. <br /> or greater) Go <br /> 1:1HAZARDOUS WASTE GENERATOR Q 3b <br /> ❑ INFECTIOUS WASTE GENERATOR \ ��01:1 WASTE STORAGE <br /> TY <br /> 1:1 NEW SITE APPLICATIONFEE `� GP <br /> yy` GP <br /> ❑ MIXED WASTE RECYCLING FACILITY �S <br /> ❑ MANURE STORAGE SITE �\s�,��\® <br /> ❑ SITE EXEMPTION APPLICATION <br /> VEHICLES AND CONTAINERS(Fill Supplemental Form) <br /> ❑ COMPACTOR TRUCK No.to be permitted <br /> In COLLECTION TRUCK No.to be permitted <br /> LJ 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 /> 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 /> ❑ 20+YARD BINS,DUMPSTERS,Roll-off&Other Containers No.to be permitted <br /> I hereby certify that I have preparedppli ion an at to t tr est of my knowledge it is true and correct. <br /> APPLICANT'S SIGNATURE X t 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 fi 8/10/81 $60.00 X <br /> .... — <br /> FEE —m_"3 <br /> LESS +� <br /> PRORATION <br /> PLUS '". --- .:_ <br /> PENALTY - -------- <br /> WE ATE <br /> OTHER 30 DQYS-X /e7 5107* of AIL®W <br /> OTHER 6U DAYS-255 g kA fi FEE <br /> 7-usFEE3 _ n? 3 <br /> Received by Date Receipt No. Permit,Np . .Issuance Date Mailed Delivered <br /> 7.-. <br /> APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERF SERVICES 1501 E.HAZELTON AVE.,P.O.BOX 2009 STOCKTON,CA 95201 <br /> �, <br />