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q <br /> Application Will 8e<,Froceaed When Property Completed.Be Sure To Sign The Application. <br /> It <br /> APPLICATION FOR INSPECTION <br /> NO CARBON NECESSARY AND R a REVOCABLE,AND PENDABLE SOLID <br /> ENVIRONMENTAL L IT <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 /> w Business Name(DBA) Harney Lane $ etrl i l _Address Lir02V 12-ram, j j2di <br /> Owner San joaQ in _Cn€ar t°+! Address' rst of PIrhlic '`n 1 1810 EHa !21tan, STuri ton <br /> g Firm Partners,Addresses and Telephone Numbers <br /> aBusiness Telephone No. Emergency Telephone No. <br /> J Franchise Area Served <br /> L Applicants Name(Print) Title Date <br /> Please check Applicable Category(9).Fill in the Required Information,Return all 3 copies. <br /> SOLID WASTE DISPOSAL SITE,NO.39- - 1)0 <br /> NEW SITE PERMIT <br /> ❑ SOLID WASTE TRANSFER STATION <br /> INDUSTRIAL WASTE GENERATOR <br /> ❑ STATIONARY COMPACTOR(20 yd.or greater) <br /> ❑ HAZARDOUS WASTE GENERATOR <br /> ❑ INFECTIOUS WASTE GENERATOR <br /> ❑ WASTE STORAGE FACILITY <br /> NEW SITE APPLICATION FEE <br /> MIXED WASTE RECYCLING FACILITY <br /> MANURE STORAGE SITE <br /> ❑. SITE EXEMPTION APPLICATION <br /> VEHICLES AND CONTAINERS(Fill Supplemental Form) . <br /> ❑ COMPACTOR TRUCK` No.to be permitted <br /> ❑ COLLECTION TRUCK No.to be permitted <br /> ❑ MOLL-OFF TRACTOR No.to be permitted <br /> ❑ ROLL-OFF TRAILER No.to be permitted <br /> (No.to be used dually Li <br /> es mped Waste°Hauler Vehicle) -- ---- - - - -- <br /> RENDERINC3,VEHICLE ,'. , No.to be permitted <br /> `,. <br /> ❑ , MANUER VEHICLE"'- ` No.to be permitted <br /> ❑ FE,,3TiLIZER VEHICLE No.to be permitted <br /> ❑ LIMITED WASTE HAULER VEHiCL 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 /> k, x <br /> 1 hereby certify that I have prepared this application and that to fhe'best of my knowledge it is true and correct :� <br /> .r <br /> APPLICANT'S SIGNATUREC -' Title oats <br /> � t <br /> FOR DEPARTMENT USE ONLY Jg <br /> Fee Is Duey. ANNUA 3,PER UNIT PER SITE 0 EACH 13 HOURLY ❑ .tan.I&Received By Jan 31 IMYIJ'ly ii Rec ilved ay X31 <br /> BASE "` E%PLANLLIN3 REMITTANCE AMOUNT DUE` " .CliECICf38 <br /> DATE' DATE REMITTED AMOirNT.. + <br /> s <br /> FEE $500.,00Due 7-31-83 _. <br /> FEE <br /> LESS <br /> PRORATION a.. <br /> PLUS, <br /> PENALTY <br /> F a <br /> OTHER r" - Al <br /> F <br /> OTHER <br /> • .,yam ., : .». ...-*: <br /> Received EN 1}ate Rece�Pt No Permigiloa Is"nici Date Maik+d w Delivered <br /> .:. .. a <br /> APPLICANT RETURN ALL COPIES TO ENVIRONMENTAL HEALTH PERMIT/SERVICEB 1601 E HAZELTON AYE,P O BOX 2009 STOCKTON,CA 96201 <br />