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Applies a Processed When Properly Completed.Be Sure T Application. <br /> �' .. APPLICATION FOR INSPECTION <br /> NO CARBON NECESSARY AND NON-TRANSFERABLE, REVOCABLE, AND SLISPENDABLE SOLID WASTE <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 /> r Business Name(DBA) Forward Inc. Disposal Site Address Austin Rd. , Stockton <br /> i Owner Forward, Inc. Address P.O. Box 6336, Stockton 95206 <br /> C <br /> J Firm Partners,Addresses and Telephone Numbers <br /> aBusiness 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 /> IN --SOOLID WASTE DISPOSAL SITE,NO.39-AA- 015 �i 0 <br /> LJ NEW SITE PERMIT <br /> ❑ SOLID WASTE TRANSFER STATION �``,,0�1`� <br /> ❑ INDUSTRIAL WASTE GENERATOR ��Cj`` <br /> ❑ STATIONARY COMPACTOR(20 yd.or greater) Q' <br /> ❑ HAZARDOUS WASTE GENERATOR %01'`? <br /> ❑ INFECTIOUS WASTE GENERATORWASTOJ ��► <br /> ❑ STRAGE <br /> NEW SIE <br /> OPPLICATIONITY FEE F0 <br /> ❑ MIXED WASTE RECYCLING FACILITYMANURE <br /> ❑ RAGE <br /> SITE EXEMPTION APPILICATION (,1''` �� O� <br /> VEHICLES AND CONTAINERS(Fill Supplemental Form) <br /> ❑ COMPACTOR TRUCK � No.to be permitted <br /> ❑ COLLECTION TRUCK X15 No.to be permitted <br /> ❑ ROLL-OFF TRACTOR No.to be permitted <br /> i <br /> ❑ ROLL-OFF TRAILER No.to be permitted <br /> (No. to be used dually as Limited Waste Hauler Vehicle) - - - - - - - - - - - - - <br /> RENDERING, <br /> - - - - - - - - - - - - <br /> 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 prethis vapplication an that to the best of my knowledge it is true and correct. <br /> ared <br /> APPLICANT'S SIGNATUR X Title Date <br /> FOR DEPARTMENT USE ONLY <br /> Fee IS Due:XX ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ HOURLY ❑ Jan.1&Received By Jan.31 XX July 1&Received By July 31 <br /> REMIT <br /> BASE EXPLANATION BILLING REMITTANCE $ AMOUNT DUE CHECKED <br /> DATE DATE REMITTED AMOUNT <br /> FEE 0 <br /> $500.00 81-82 7/1/81 Due 7 31 8 O <br /> FEE <br /> LESS <br /> PRORATION <br /> PLUS <br /> PENALTY - 0 `• - - !t - ..v. v, ,,� Ji7UvVN B LOW <br /> OTHER 3�./ `+,`1� - ", 1•...J ,I )ASE60 i C <br /> r <br /> of BASER-E <br /> WV <br /> OTHER 90 DAYS-25% of BASE RE <br /> Received by Date Receipt No. Permit Nos. Issuance Date Mailed Delivered <br /> APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1801 E.HAZELTON AVE.,P.O.BOX 2009 STOCKTON,CA 95201 <br />