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Application Processed When Properly Completed. Be Sure To Sign Application. <br />APPLICATION FOR INSPECTION <br />NO CARBON NECESSARY AND NON -TRANSFERABLE, REVOCABLE, AND SUSPENDABLE 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 />y <br />Business Name (DBA) SAN JOAQUIN GENERAL HOSPITAL Address 500 W, HOSPITAL ROAD — FRENCH CAMP 95231 <br />i Owner COUNTY OF SAN JOAQUIN Address 222 E. WEBER AVENUE — STOCKTON, CA 95201 <br />a <br />J Firm Partners, Addresses and Telephone Numbers <br />ILL Business Telephone No. (209) 982-1800 Emergency Telephone No. SAME <br />Franchise Area Served <br />Applicants Name (Print) STEVEN P. EBERT Title DEPUTY DIRECTOR Date 05-28-85 <br />Please check Applicable Category(s). Fill in the Required Information, Return all 3 copies. <br />SOLID WASTE DISPOSAL SITE, NO, 39 -AA - <br />NEW SITE PERMIT <br />SOLID WASTE TRANSFER STATION <br />INDUSTRIAL WASTE GENERATOR <br />STATIONARY COMPACTOR (20 yd. or greater) <br />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 <br />❑ COLLECTION TRUCK <br />❑ ROLL -OFF TRACTOR <br />❑ ROLL -OFF TRAILER <br />(No. to be used dually as Limited Waste Hauler Vehicle) <br />❑ RENDERING, VEHICLE <br />❑ MANUER VEHICLE <br />❑ FERTILIZER VEHICLE <br />❑ LIMITED WASTE HAULER VEHICLE <br />❑ LIMITED WASTE HAULER TRAILER <br />❑ 20 + YARD BINS, DUMPSTERS, Roll -off & Other Containers <br />No. to be permitted <br />No. to be permitted <br />No. to be permitted <br />No. to be permitted <br />No. to be permitted <br />No. to be permitted <br />No. to be permitted <br />No. to be permitted <br />No. to be permitted <br />No. to be permitted <br />I hereby certify that I have prepared this a lication and that to the best of my knowledge it is true and correct. <br />APPLICANT'S SIGNATURE xa Title DEPUTY DIRECTOR <br />Date 05-28-85 <br />FOR DEPARTMENT USE ONLY <br />Fee Is Due: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ HOURLY []Jan. 1 & Received By Jan. 31 ❑ July 1 & Received By July 31 <br />BASE <br />EXPLANATION <br />BILLING <br />DATE <br />REMITTANCE <br />DATE <br />$ <br />REMITTED <br />AMOUNT DUE <br />REMIT <br />CHECKED <br />AMOUNT <br />FEE <br />FEE <br />LESS <br />PRORATION <br />PLUS <br />PENALTY <br />OTHER <br />OTHER <br />Received by Date Receipt No. Permit Nos. Issuance Date Mailed Delivered <br />