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APMoeYMs YM IN Processed WAse Sub ~P.Opef y Compleed.9e Sure l'o SW The AppRcalon. <br /> r. APPLICATION <br /> •, (Far Na TrM1MvaW.ReroeMle.end SuspeRRUble) <br /> ENVIRONMENTAL HEALTH PERMIT <br /> is r' LI"m WASTE <br /> iyy — <br /> Applrcetion is Soy made G al bus, I ttheI rd <br /> ri Wnw area OI the n,r�sun LOCaI{uel�p trKt <br /> h re�a�N.�nr(oeA) LEE Lrt1ALL. 61�( �C�r� <br /> svE� owner t. �E.�L111 Add. — <br /> ..Y` Firm Panus.Aadrauaa end <br /> Buslasse Telephone No ��P�_--- Emergency TrtMOMna No. •4 <br /> -1 Gb11VM.7er UOMoe No._ J �L <br /> l!�DM'tsNMrr(Print)..l.��l=�Al R 1 T { eR� Title <br /> r?_ t phase cJraM Appbc"Cale9oy,(1.7)and FM in M Required Ielerr all— <br /> ,1. O P(MIPER V6NICLE PERMIT REGISTRATION(FOR EACH VEHICLE) n <br /> .sor July I.___June 30,19 Disposal Sit" •^) <br /> Co" -a <br /> DesnrWSon(k1akM1'r. —_ —_ _ — — .77 <br /> L.ens. No. CAL.Licwne No. —___._CAL..Lfpsrw Renswal N0. — <br /> Cepedty _— Gal..Wilights 6 Meaaurse No. <br /> Equipment Parking Addrae. <br /> POWMR VMD <br /> s.. For July 1, Jure 30.19 <br /> i+^• - N0.of 1'ehicise Stored - <br /> A $' ;e <br /> .y.,, No.of ChlwniW Tallw Stored - <br /> 0. O-PERCOLATIOI/TEST <br /> R$Lor R.C.E.Neer _ RS.or R.C.E.No._ <br /> AA! Text location Test Dat?/Tirne <br /> i. O SANITATION PE <br /> Jolt Addremn=aWn J <br /> O SEPTIC TANK 'DCESSPOOL ^fXLEACHING FIELDSEEPAGE PIT O PACKAGE PLANT 1 <br /> O gERMANEy T ' O TEMPORARY O NEW IREPAIR O OTHER (� <br /> S. 0 CHEMICAL TOILETS For July 1.-June 30.19 CA <br /> - <br /> Typo Construction— —Disposal Site --jam <br /> No.D'Urits Equlpment Sonige/Cleaning Location(EI <br /> ' S. O PACKAO[TREATMlfNT PLANT For July 1,-June 30.19 <br /> Opm or"Mer ____ — Whine Cer9Ma— <br /> Plane Location — <br /> P1Md Capecly — No.Unita ServedT. O LALRIDRy For July,7.-Jury 30.19 <br /> SIZE: O Lsea Tnan 1A00 Sq.FL. O Lon Ttrn 1.000 5p.FL <br /> #p O ORy CLEmmo.CMmoats Usoct mIcuovmo. -- _ <br /> rhenr..n.r«7oenW eeMq'e dewaaeeeeeTwdn lerss4�'ecernMRar I.lNpeksawKed sRraY IMrMCtl Wsper"Is immA l"rAlav*yanpw:� <br /> ewtllaslwMrroeW ou wlhWH a shp ca <br /> larr{faGkNnu <br /> �9eRaa � « � ew'e sYwla�at�a raeowrr� Iun.h tMnMwbwuKa shin rrork lM rtprA ink grWLN 4RIM.ISI10 <br /> 1 twrw only t I Drepareo t appllcauon d mat IM work Will lee done in eccordanc:e wile San Joaquin County , <br /> onuuncse,flet* no • u to oil an Joa It LHealth DistrK:L <br /> AppL.CANTS SIGNATURE X -- --- /� -�j — <br /> SSL FOR DEPARTMENT USE ONLY <br /> Fad in Due:O ANNuauy p"m LIMIT <br /> ❑_,cA__sI <br /> .r-_E_._Q. _EA.CH_—O__J ,1 <br /> 1 Kinw_ Tr 0A1qeyw <br /> Or <br /> AENIT <br /> sntEAATION AMOUNT WE CHECKED� ~ WT[ FREMITTED euamT <br /> s <br /> IC <br /> Y- <br /> eEW pIDR11TK)M 1 <br /> 4_/L.7--__1-- __--___— — -- <br /> ftus <br /> OTHER — -- <br /> - _ jrx _ ta�c(f _tees P <br /> R.`..o•rio a.�r No —,:�v OM—Ywa Owww�a--- <br /> 1 `A/IJ[yR—R1T111r 41 COeta 1R [rgl^wrrlriLL lrrALlH rfgYs,uRYKas NeltMaaLTOMAK.R4Mare afOCRTeN GMrr <br /> y <br />