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Applications Will Be Processed When Submitted Properly Completed. Be Sure To Sign The Application. <br /> APPLICATION ` <br /> (For Non-Transferable, Revocable,and Suspendable) SEPTAGE <br /> ENVIRONMENTAL HEALTH PERMIT <br /> LIQUID WASTE <br /> Application is hereby made to carryon business in the jurisdictional area of the San Joaquin Local Health District <br /> +n Business Name (DBA) World Enterprises Address Box 8598, Stockton_ 9 5208 <br /> i Owner Address <br /> Firm Partners, Addresses and Telephone Numbers _Donald Lawley & Rex Wharton, 3927 Clark Dr.-, Stockton <br /> aBusiness Telephone No. . 1(66-0717 -- Emergency Telephone No. <br /> Contractor Licence No. 26 611 <br /> LApplicants Name (Print) Barbara Lawley Title Office Manager Date April 9 , 1981 <br /> Please check Applicable Category(1-7) and Fill in the Required Information. <br /> 1. ❑ PUMPER VEHICLE PERMIT REGISTRATION (FOR EACH VEHICLE) <br /> For July 1, June 30, 19 Disposal Sites <br /> Description(Make/Yr., Calor) <br /> Serial No. CAL. License No. CAL. License Renewal No. <br /> Capacity Gal., Weights & Measures No. 1 <br /> 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 <br /> R.S. or R.C.E. Name 5 R.S. or R.C.E. No. <br /> Test Location t --- Test Date/Time <br /> 4. ❑ SANITATION PERMIT <br /> Job Address/Location - 8590 N. Main Street, Manteca, Ca. <br /> Owner Guarantee Savings & Loan Address 770 E . Shaw Ave. , Fresno, Ca. 93710 <br /> ❑ SEPTIC TANK ❑ CESSPOOL ❑ LEACHING FIELD ❑ SEEPAGE PIT ❑ PACKAGE PLANT <br /> ❑ PERMANENT ❑ TEMPORARY ❑ NEW ❑ REPAIR XX OTHER Septic Tank Removal <br /> 5. ❑ CHEMICAL TOILETS For July 1,-June 30, 19 <br /> Type Construction Disposal Site T <br /> No. of Units Equipment Storage/Cleaning Location(s) <br /> 6. ❑ PACKAGE TREATMENT PLANT For July 1, -June 30, 19 <br /> Operator Name Where Certified + <br /> Plant Location <br /> Plant Capacity No. Units Served <br /> 7. ❑ LAUNDRY For July 1,-June 30, 19I S^/� <br /> SIZE: ❑ Less Than 1,000 Sq. Ft., ❑ More Than 1,000 Sq. Ft. D <br /> ❑ DRY CLEANING, Chemicals.Used/Amount/Mo. <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, state laws, and rules and regulations of the San Joaquin Local Health District. <br /> APPLICANT'S SIGNATURE X <br /> x r <br /> FOR DEPARTMENT USE ONLY <br /> 5 <br /> Fee Is Due: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ January 1 &Received By January 31 ❑ July 1 &Received By July 31 <br /> REMIT <br /> BILLING REMITTANCE $ <br /> BASE EXPLANATION BILLING DUE CHECKED <br /> - <br /> DATE— -DATE- -- REMITTED• - ---- AMOUNT <br /> FEE �O IWO a <br /> LESS <br /> PRORATION <br /> PLUS <br /> PENALTY <br /> OTHER <br /> OTHER <br /> `-PI q_�— eta 673 16386 -1 -81 <br /> Received by I Datef Receipt No. Permit No. Issuance Date it Delivered <br /> APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1601 E.HAZELTON AVE.,P. ,p 09 STOCKTON,CA 95 <br />