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Apphclions Will Be Pc"s�' ed When SubPmittedPLICATION Property Completed. Be Sure To sign The Appli atiOn <br /> a <br /> A <br /> (For Non-Transferable,Revocable,and Suispendable) SEPTAGE <br /> ENVIRONMENTAL HEALTH PERMIT <br /> LIQU119 WASTE <br /> on business in the area of tryq Sari Joaquir Locai Health District <br /> A60naVorl�s hereby made 10 carry Address <br /> Name <br /> Addres$ <br /> � Frr, paq,erT, Ain-wises and Telephone Numbers Emergency Telephone oto.--- <br /> I Title -e-s-r.................... 08'e <br /> PI.ease check A.,ijeable (�aleqory tl.7) and Fitt in the Required infor""n <br /> 1, C, PUMPER VEHJCLE PIERPAIT REGISTRATION(FOR EACH VEHICLE) <br /> June 30 19 Disposai Sites .......... <br /> 4make.ry'', cowo ........................... <br /> CAL. LtcenSD Renewllrl Nor <br /> CAL,LicerSe <br /> 43'yf.a! No - -----,- -- <br /> Gai Weights Measures a............... ....... ............... ...... <br /> ............................ <br /> Equiorr',Pnl pariqr-9 AOdres,, <br /> PUMPER YAMD <br /> ............................... <br /> ea! chernical ToLleis Stored ................... <br /> 3. 0 FERCOLAT1ON TEST R.S. of R.C.E. No. ...................... <br /> ofR.CE. Narne <br /> Test Oate/Time <br /> A <br /> SANITATION PERWT ................ <br /> )CA, <br /> owner 01-6 A Address 13 PACKAGE PLANT <br /> LEACHING FIELD 0 SEEPAGE PIT 0 OTHER <br /> X REPAis <br /> SEFTIC-1 At4K CESSP00t, <br /> T MPORAWY NEW <br /> J PERMANEN 30, 19 <br /> L-J CmEMICALT01ILETS FO" i JameDisposai Site........... — <br /> F-,,,pMgnt StOTaqe/Cleaning LOCZI`tion�s) <br /> No. of Un,t�� ..........- -- --- - (), A 9 — - <br /> PACKAGE TREATmENT PLANT For Ju,tY 1, -June 3 Where certified <br /> .Operatcr ........................................ <br /> ........... <br /> Gant LC,(;,4<or No. Units Served <br /> plaracapacily <br /> 7 0 k.AUNDFIY For Jaly I June 30 19 Ft. <br /> LeS'�"r�tar" ' f)09 c,�q Ft . El more Than 1,000 ........ <br /> C] DRYCLEANiNG Chemicals <br /> he work will be done in accordance With San Joaqt' (''otjr�:Y <br /> Y thaL � nave oaquin LoC81 Health Disitict. <br /> cerni prepared this application and thal t <br /> igrgBV ruler and reguialions Of ttie San J <br /> state jaws, and <br /> 7 <br /> x <br /> FOR DEPARTMENT USE ONLY <br /> - ------ 0 July I & <br /> &HeeCivtad By�anuafy:�l <br /> Fee if Due: ANNOAL11.1� 0 7' S AMOUNT DUE CHFCKED <br /> I Rr-N417TANCE 1 FA 11 U<I" AMOUNI <br /> BILLING I REJA�TTED <br /> DATE <br /> l (SASE- iEAPLANAI ION DATF <br /> W. <br /> L\ 7777- <br /> .......----------....... ....... <br /> 'w ansa Dal STOCK'TON,CA <br /> * <br /> iii ,F.+JAZr:L,roN AVE.,P.OL B <br /> ex 2604..roMMIEENTAL HEAV'r"PERMIT13FIRVIOES <br /> VAN ALL COMES To <br />