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Applications Will Be Processed When Submitted Properly Completed. Be Sure To Sign The Application. <br /> APPLICATION <br /> (For Non-Transferable, Revocable, and Suspendable) SEPTACE <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 /> N Business Name (DBA) WONG ENGINEERS, INC. Address 4578 Feather River Dr, Suiae A <br /> i Owner C . CHANCE WONG Address Stockton CA 95207 <br /> C <br /> J Firm Partners, Addresses and Telephone Numbers <br /> a Business Telephone No. 476-0011 Emergency Telephone No. <br /> a <br /> Contractor Licence No. <br /> L Applicants Name (Print) C . CHANCE WONG Title PRES . Date_29 FER-88 <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 /> 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. KRPERCOLATION 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 13396 S Castle Road Test Date/Time <br /> 4. ❑ SANITATION PERMIT M.S . 87„95 <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 prepared this application an t e work will be done in accordance with San Joaquin County <br /> ordinances, state laws, and rules pr sof th�Wi uin Local Health District. <br /> APPLICANT'S SIGNATURE X <br /> FOR DEPARTMENT USE ONLY <br /> FeIs Due: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EAC EJ January 1 &Received By January 31 ❑ July 1 &Received By July 31 <br /> Jl BILLING EM A E REMIT <br /> =BASE EXPLANATION DATE REMITTED AMOUNT DUE CHECKED <br /> AMOUNT <br /> FEE 50.. ho 5d <br /> LESS <br /> PRORATION <br /> PLUS <br /> PENALTY <br /> OTHER <br /> OTHER <br /> Received by Date Receipt No. Permit No. Issuance Date Mailed Delivered <br /> k6— APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1601 E.HAZELTON AVE.,P.O.Box 2009 STOCKTON,CA 95201 <br />