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Applications Will Be Processed When Submitted Properly Completed. Be Sure To Sign The Application. <br /> APPLICATION <br /> *,Wr Non-Transferable,0111ioeft-le,and Suspendal*.,, SEPTAGE <br /> ENVIRONMENTAL HEALTH PERMIT <br /> LIQUID WASTE <br /> Application is hereby made to carry on business in the jurisdictional area of the San Joaquin Local Health District <br /> ,„Business Name (DBA) WONG ENGINEERS. INC. Address 210 N. HUNTER, STOCKTON 95202 <br /> a Owner_ C . _CHANCE 1VONGAddress <br /> J Firm Partners,-Addresses and Telephone Numbers — <br /> o. Business Telephone No. 464-4G32 _-- -__ Emergency Telephone No. <br /> Contractor Licence No. <br /> Applicants Name (Print) C. CHANCE WONG _ Title FRES. Date OL-13-85 <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.,Color) <br /> Serial No. - CAL. License No. CAL. License Renewal No. <br /> Capacity _ Gal., Weights & Measures No. -- <br /> t <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 C CHANCE WONG R.S. or R.C.E. No. R.C.E. 14269 <br /> Test Location 13039 S. 99 FRONTAGE Rl). Test Date/Time <br /> 4. ❑ SANITATION PERMIT MS-85-66 <br /> Job Address/Location - - - <br /> Owner Address <br /> ❑ SEPTIC TANK ❑ CESSPOOL ❑ LEACHING FIELD ❑ SEEPAGE PIT ❑ PACKAGE PLANT <br /> ❑ PERMANENT ❑ TEMPORARY ❑ NEW ❑ REPAIR ❑ OTHER <br /> 5. ❑ CHEMICAL TOILETS For July 1, - June 30, 19 <br /> Type Construction Disposal Site <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, 19 <br /> SIZE: ❑ Less Than 1,000 Sq. Ft., ❑ More Than 1,000 Sq. Ft. <br /> ❑ DRY CLEANING, Chemicals Used/Amount/Mo. <br /> I hereby certify that I have pre red this application and tha he or will be done in accordance with San Joaquin County <br /> ordinances, state laws, and ru n reJ�PI tions of the San oa o al Heal District. <br /> APPLICANT'S SIGNATURE X <br /> GCC c /l <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ January 1 6 Received By January 31 ❑ July t &Received By July 31 <br /> WA <br /> BASE EXPLANATION BILLING REMITTANCE $ AMOUNT DUE <br /> C // ( / DATE DATE REMITTED FEEO )LESS -PRORATION <br /> PLUS <br /> PENALTY <br /> Q(7�OTHER 70"a <br /> OTHER <br /> Received by Date Receipt No. erm Issuance Date Mailed Delivered <br /> APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1601 E.HAZELTON AVE.,P.O.Box 2009 STOCKTON,CA 95201 <br />