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Applications Will Be Processed When Submitted Properly Completed.Be Sura To Sign The Applieallon. J <br /> _ APPLICATION <br /> (For Non-T,ansferable,Revocable,and Stfspendable) r,_ r <br /> ENVIRONMENTAL HEALTH PERMIT SE FL,., <br /> LIQUID WASTE Y <br /> Application,s hereby mado to r.,,ry on bu;,n-;,r,,the jurisdictional arca of the San Joaquin LoCal Haailh Dfsaltl <br /> Name(DBAI D. Q -✓S Address �O�tX.( I►Z7 - -S7&N -- <br />�; Address -- <br /> PaOrefs. Addresses and--LLTelnnhono N-imbn••. -•------ '� <br />^ ss Telephone No. TG fo -7G o ) Emergency Telephone NO. -- .___�.-------— - <br /> t <br /> ractor Licence No �- <br />,rants Name (Pr,n:, eLOyD 1_1 h line 4i:;5r/,►IA727)C Does ./Q; -- <br /> se c". ck Applicable Catego-y (1-7)and Fill In the Requlrec;Information <br /> 3 PUMPER VEHICLE PERMIT REGISTI,ATION(FOn EACH VEHICLE) 11 <br /> lvty 1. June 30 19 :n•;al Sttea - ,V <br />;npthon(Make(Yr,Color( T <br />), No CA;. L,censr,No CAL Llcenw ReMwal NO. � <br /> arty Gal..Weights P. I',.acures No -- <br /> P:nr.nt Farkmq Address -^ -- --- <br /> PUMPER YARD <br /> July 1. June 30. 19 <br /> u!Chemical Toilets " 'ed --- --- <br /> PERCOLATION 1. aT <br /> nr R C E.Name R.S.of R C E.No. <br /> t <br /> ora-,on Test Cate/Time e <br /> SANITATION PERMIT <br /> A,.,1101,s Location 1/..I-r.lr /Yf ICX0'y &O" c•6E RD, �Opi Cif <br /> )46025"X" T.A`A&'/S Aut,ress /O/aT A)VS.4 0,0 r WtD4C.Z71u <br />;FPTIC TANK IkESSP,IOL LF A'.'• I LD R' SEEPAGE PIT ❑ PACKAGE PLANT <br />`FPh1ANENT C TEMPORARY ":I ❑ REPAIR U OTHER <br /> CHEMICAL TOILETS For J�,'> <br /> c ConatruCtlon "le <br /> r I„ ening I ocathun(s) <br /> PAI-KAGE TREATMENT PLANT I 19 <br /> r tic.Name Where Cerhhed <br />�i t• v,on <br />,t C.,racay No tints Served <br />❑ LAUNDRY For July 1. -June 30 14 <br /> F ❑ Less Than 1 Opp Sq Ft ❑ kiwe T•'• It <br />)FV, CLAN IG.Chemicals Used'Amn.int Mn <br /> I netAby cert•ly that I nakN V'evaft••f " and that the wort win tM done rrt accorWr.'a wilh San Joagwn Cs)unty <br /> ;,ed.nances state taws a,d Owes and•• ' ^ an Jcaqu,n Locaf Hoatrh D-3frrCt <br /> A•r'S SIGNATURE X S- <br /> FOR DEPwATMENT USE ONLY <br /> A%% A.. ❑ ❑ t a, . ❑ v,_.r, •,N.rtt ri Pr J.6- r 1' 0 kow I&a---,I If, A" )I <br /> fee If DW'❑ p[y1. <br /> AVou-41 Def Ce407a1 <br /> oe <br /> 7 ex <br /> are;.�Arrt-IfElVrftr•tt COt••ES•a rw. o.wuFw•a - ..t•FwWt sErlrrt[S Net a.104AM[oaf Ata[.e 0 son afM e[pCa[or CA Maft <br />