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• 1 <br /> State of Californla—Health and Welfare Agency Department of Health Services <br /> ...- "� Toxic Substances Control Division <br /> 714/744 P Street ! <br /> Sacramento,CA 95914 I; <br /> HAZARDOUS WASTE HAULER APPLICATION !j <br /> Check here if applicant has previously been registered in California. ❑ <br /> i <br /> I-vm Name(Show name exactly as It should appear on permit;same name should be on all vehicles.) <br /> STOCKTON CONTRACTING GROUP, INC. <br /> Business address No./Street City/Town County Zip Code Telephone No. <br /> 1000 N. Union Street Stockton, Ca. San JOaquin 95205 (209) 462-5082 <br /> Mailing address(if different) P.O.Box/Street City/Town Zip Code <br /> NONE <br /> Hauler Registration No. (If renewal) U.S.t!ir omental Protection Agency (EPA) (dent fication No. <br /> LOOOfZ�x3 b0 <br /> Note: List additional EPA ID Nos with their addresses on a separate sheet <br /> OWNERSHIP OF FIRM (List all owners;partners if a partnership;corporate officers if a corporation.) <br /> - - Name - - - - Residence Address(except for corporatepfflcen) Position - <br /> -CorY d aWarren — r- President <br /> Jerry JOy Vice-President <br /> Yon Sim Warren <br /> FEES REGISTRATION FEE I—P veF;des $ 200.00 <br /> i <br /> VEHICLE/CONTAINER INSPECTION FEES 0 or mer_-';chicles $500.00DO <br /> (Total from Application for Vehicle/Container Inspection) S <br /> TOTAL FEES $ Q0 <br /> (Make check payable to DEPARTMENT OF HEALTH SERVICES) r�-�--- <br /> I understand and will comply with the applicable requirements of Chapter 6.5, Division 20, of the California Health and Safety Code and <br /> Chapter 30, Division 4, Title 22, of the California Administrative Code. <br /> I certify under penalty of perjury to the accuracy of all statements made herein. <br /> Name of Authorized Agent(print or type) Title <br /> Jerry Joy Vice=President <br /> Signature Of Authorizetl Agent Date <br /> 2/3/89 <br /> I <br /> EH 187(12/85) <br />