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-AFIjUCATIUN <br /> + k. (For Non-Transferable,Revocable, and Suspendable) SEPTAGE <br /> ENVIRONMENTAL HEALTH PERMIT <br /> LIQUID WASTE <br /> n business in the jurisdictional area of the$a:OJoa�u�i XLJ� ealt po�rcOTk 95OS ' <br /> Application is hereby made to carry Address P L <br /> 'J Valley Mechanical Inc- <br /> Business geld Linden. CA <br /> r Business Name (DBA) Address <br /> owner Geor e 3. .Fleck i <br /> IJ Firm Partners, Addresses and Telephone Nu 1 bers Emergency Telephone No. , <br /> 1--�0 1 <br /> aBusiness Telephone No. 333319 <br /> a Contractor Licence No. Title ESti �er Date <br /> Mel Thweatt <br /> L Applicants Name(Print) r <br /> Please check Applicable Category (1-7) and Fill in the Required Information r <br /> 1. <br /> El PUMPER VEHICLE PERMIT REGISTi ATION (Dop s( ACH Disposal <br /> al Sitesi <br /> For July 1, June 30, 19 <br /> Description(Make/Yr.,Color) CAL. License Renewal No. <br /> 1 CAL. License No. I <br /> Serial No. <br /> Gal., Weights &Measures No. <br /> Capacity <br /> I Equipment Parking Address <br /> 2. ❑ PUMPER YARD <br /> For July 1, June 30, 19 <br /> No. of Vehicles Stored <br /> No. of Chemical Toilets Stored <br /> 3. ❑ PERCOLATION TEST R.S. or R.C.E. No. <br /> R.S.or R.C.E. Name I Test Date/Time <br /> Test Location <br /> 4, M SANITATION PERMIT <br /> 10100 W. 'Linne Road Trac CA 95 76 CA 95376 <br /> Job Address/Location P.O. Box 713 Trac ' <br /> LMERON Pi Divi SiOn Northern C,�+L Addressowner j] PACKAGE PLANT <br /> IX SEPTIC TANK ❑ CESSPOOL 113 LEACHING FIELD 0 SEE E REPAIR <br /> 1:3 OTHER, <br /> J 11 PERMANENT ❑ TEMPORARY I a NEW # -1 SEPTIC TANKS - 1200 GALLONS EACH -- <br /> [ 5, ❑ with 100' leach lineCHEMICAL TOILETS For July 1, -June 30, i9 2 SEPTIC TANKS - 1600 GALLON��H <br /> Type Construction ( Disposal Site v <br /> No. of Units Equipment Storage/Cleaning Location(s) with 300' leach line d <br /> 6. El PACKAGE TREATMENT PLANT� For July 1, -June 30, 19 where Certified <br /> I Operator Name i I <br /> Plant Location I No. Units Served <br /> Plant Capacity <br /> k 7. 13 LAUNDRY For July 1, - June 30, 109 More Than 1,000 Sq. Ft. <br /> SIZE: ❑ Less Than 1,000 Sq. Ft., <br /> ❑ DRY CLEANING, Chemicals Used/Amount/Mo. <br /> 1 <br /> s [� <br /> i l hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County [� <br /> state laws, and rules and regulations of the San Joaquin Local Health District. <br /> ordinances, <br /> APPLICANT'S SIGNATURE X <br /> 'I FOR DEPARTMENT USE ONLY <br /> Received By January 3t ❑ July t B Received By July 31 <br /> January <br /> 13 REMIT <br /> �. Fee IS DUe: ❑ ANNUALLY ❑ PER UNIT ❑ PER'S1TEgILL1❑ EACH REMITTANCE $ AMOUNT DUE CHECKED <br /> BASE EXPLANATION DATE <br /> DATE REMITTED AMOUNT <br /> F <br /> O <br /> FEE <br /> LESS <br /> PRORATION <br /> ` P �# <br /> PENALTY <br /> hI <br /> OTHER <br /> OTHER <br /> Receipt No. Permit No. <br /> Issuance Date Mailed Delivered. <br /> Received by Date 1601 E.,HAZELTON AVE.,P;ONBox 2009 STOCKTON,CA 85201 <br /> APPLICANT—RETURN ALL COPIES TO,. ENVIRONME14TAL-HEALTH PERMITISERVICES <br />