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Applications Will Be Processed When Submitted Prop" Completed. Be Sure To Sign The Application. APPLICATION (For Non -Transferable, Revocable, and Suspendabie) ENVIRONMENTAL HEALTH PERMIT atV"Win A&VC I I AP I pljutlOn4s h r It rrs tage try on bus/fires 'ntr sd clional area of the Address ri Businessr Owner Address . ........ SEPTAGE at7 Firm Partner,;, Addresses an T t .0 e N berS Telephone No. Emergency M. Business Telep- Y'7 It e Contractor UC rice Na Title .-.j& Dow LApplicants Name (Print).__X Please check Applicable Ca1*60rV (1-7) and fill in 1h* Requited lvilonnation 1, 0 PUMPER VEHICLE PERMIT REGISTRATION (FOR EACH VEHICLE) For July 1, ........ . ... — June 30,19_._ Disposal Sites Description (makefyr" Color) SerialNo.-- Capacity . ... ... .. Equipment Parking Address 2. rl PUMPER YARD - CAL. License No. , Gal , weights & measures No, . . . ......... . OAL— LIOMM FWW4VW No. A" For juiyl.--- June 30,19 No, of Vehicles Stored No, of Chemical Toilets Stored 3. t1 PERCOLATION TEST ps, or R.C.E. No. .... . . R.S. or R.C.E. Name Test CateiTime Test Locall0r, 4. CZSANITATION PERMIT Job Address/ atio"I Owner o' R" Address- RSEPTIC TANK El CESSPOOL f-ILEACHING FIELD 2-sr-EPAGE PIT 112 PACKAGE PLANT G-I�E_RMANENT 0 TEMPORARY Q-hE\N 0 REPAIR 0 OTHER C3 CHEMICAL TOILETS For July 1, June 30, 19 j Construction Disposal Site . .... . .... Ivo. of Units Equipment Storage/C leaning Location(s) 6. 11 PACKAGE TREATMENT PLANT For July 1, - June 30, 19 Whom Certified Name . ....... Plant Location No. Units Served ....... Plant Capacity 7. 0 LAUNDRY For July 1, - June 30, SIZE- Less Th;iri 1.000 Sq. Fl_ C1 More Than IS= Sq. Ft. 0 DRY CLEANING, Chemicals Used/Amount/Mo. I hereby Certify that I have prepared this ordinances, State laws, and _rWes a d regul APPLICANT'S SIGNATURE Fee Is Due: 0 ANNUAVI-Y BASE and that the work will be done in 30cofoance, with San Joaquin County *6an Joaquin Local Health District. FOR DEPARTMENT USE ONLY PER UN T [3 PE41 SITE El EACH jfintjar iiTHER HITHER APPLICANT—RETURN ALL COMES TO: W#AiTTAN EIrBLING CEXPLANAI'M DATE OATF D 31 C] Jut" t 8 Ree.'"nVed Fly July 31 AMOUNT DUE 4r Y . . . ... ...... I"uAnco 160, F j4AnLTON AVE..p,o. 91 20M STOCKTON, CA ENVIRONMENTAL HEALTH nAMMSERViC" Yee A ALL FEE LESS PRORATION PLUS PENALTY and that the work will be done in 30cofoance, with San Joaquin County *6an Joaquin Local Health District. FOR DEPARTMENT USE ONLY PER UN T [3 PE41 SITE El EACH jfintjar iiTHER HITHER APPLICANT—RETURN ALL COMES TO: W#AiTTAN EIrBLING CEXPLANAI'M DATE OATF D 31 C] Jut" t 8 Ree.'"nVed Fly July 31 AMOUNT DUE 4r Y . . . ... ...... I"uAnco 160, F j4AnLTON AVE..p,o. 91 20M STOCKTON, CA ENVIRONMENTAL HEALTH nAMMSERViC" Yee A ALL