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Application Will Be Procemied When Property Completed. Sure To Sign The Application. <br /> APPLICATION INSPECTION <br /> NO CARBON NECESSARY ANR�ftANSFERABLE,REVOCABLE,AND _. SOLID A TE <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 /> Or Business Name(DBA Lovelace Tranfer' Station Address CVS' ME t' a�tlt Ca <br /> zOwner San J gain County address 01-2ts PUbliC 11c� R` 1F fla7elton. Stockton <br /> v Firm Partners,Addresses and Telephone Numbers' <br /> c 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,Retum all 3 copies. <br /> SOLID WASTE DISPOSAL SITE,NO.39- - <br /> NEW SITE PERMIT <br /> X11 SOLID WASTE TRANSFER STATION <br /> 13 INDUSTRIAL WASTE GENERATOR <br /> 01 STATIONARY COMPACTOR(20 yd.or greater) <br /> 11 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 /> 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 /> 0 <br /> ---- - _❑ RENDERING,VEHICLE No.to be permitted <br /> MANUER VEHICLE No.to be permitted ` <br /> FERTILIZER VEHICLE ,� No.to be p®rmitled <br /> ❑ LIMITED WASTE HAULER VEHICLE i No.to be permitted' <br /> ❑ LIMITED WASTE HAULER TRAILER No.to be permitteif <br /> ❑ 20+YARD BINS,DUMPSTERS,Roll-off&OtherContainersNo.to be permitted <br /> • <br /> I hereby certify that I have prepared this application and that to the best of my knowledge it is true and correct k <br /> APPLICANT'S SIGNATURE `" Title <br /> r� x <br /> ' 'FOR DEPART ENTUSE ONLY <br /> Fee Is Du@ a�,A A'LLY '11.P&LIN IT 1"1 PEA SITE EAC!l -HOURLY © dan.1&Received By Jan S1 atly & By JuRE <br /> ly 31 <br /> SASE 'EXPLANAt!04 " BILLING REMnTAwCE $p AMOUNTt3UE CHECKED <br /> , <br /> DATE `_"� DATE REMI TED- _ : ao � �,' N7 <br /> FEE <br /> FEE <br /> LESS, 49 <br /> F <br /> PRORATION r. <br /> PLus <br /> PENAL Y <br /> OTHER <br /> , cITHER,� a ,. �y .�'�� '' ���` i,� a#�� '�" +tns�.� �t�`�y>�u � �� � r sk_,f�x 1 �� � •.��:re , �'� <br /> Is <br /> Received by Date Race+pttva t Permit Nee issuance Date Nlaii�i Delewered <br /> C RETURN AL IES TO. ENVIRONMENTAL H TN R IT/S VI 18D1 E H T AVE R 4 aOX ON, <br /> » �, "•. a .-...`��'nw ki'e5, ,,�' ;�:+.t4'�.�-N.a` ; a M,.��. � °", ,� th' ', h , +` <br />