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• ' Applicatlo Be Proce�{red When Properly Completed.Be Sure To Sora Application. <br /> APPLICAiTION FOR INSPECTION <br /> NSCAR%dN NECESSARY AND NON-TRANSFERABLE, REVOCABLE,AND SUSPENDABLE SOLtU­WASTE <br /> ENVIRONMENTAL HEALTH PERMIT <br /> SOLID WASTE <br /> Application is hereby made to carry on business under Permit in the jurisdiction area of San Joaquin Local Health District. <br /> OF Business Name(DBA) French Camp Disposal Site Address Manthey Rd. & I-5 <br /> = owner City of Stockton Address 1465 S. Lincoln St. , Stockton 95205 <br /> j Firm Partners,Addresses and Telephone Numbers <br /> C <br /> Business Telephone No. Emergency Telephone No. <br /> Franchise Area Served <br /> �Applicants Name(Print) Title Date <br /> Please check Applicable Category(s).Fill in the Required Information,Return all 3 copies. <br /> XX0 SOLID WASTE DISPOSAL SITE,NO.39-AA- 002 vz <br /> ❑ NEW SITE PERMIT <br /> ❑ SOLID WASTE TRANSFER STATION <br /> 11INDUSTRIAL WASTE GENERATOR <br /> 11 STATIONARY COMPACTOR(20 yd.or greater) � �JQ� <br /> ❑ HAZARDOUS WASTE GENERATOR1F" <br /> 1:1 WASTE STORAGE RARE FASTE GIL TY GENERATOR `0���© <br /> O G C ss <br /> ❑ NEW SITE APPLICATION FEE <br /> 11 MIXED <br /> MIXED WASTE RECYCLING FACILITY <br /> ❑ MANURE STORAGE SITE �� i <br /> ❑ SITE EXEMPTION APPLICATION <br /> VEHICLES AND CONTAINERS(Fill Supplemental Form <br /> .❑ §OMPACTOR TRUCK No.to be permitted V���dddd <br /> OLLI:CTION TRUCK No.to be permitted <br /> I._,. I <br /> -rLP-OFF TRACTOR No.to be permitted —� 1 2 <br /> 'MDL4',1,,FF TRAILER No.to be permitted <br /> C �,(.�Vo. to be used dually as Limited Waste Hauler vehicle) - - - - - - - - - - - - - "AL1H DIST. <br /> ❑ lkENB RING,VEHICLE No.to be permitted H LOCAL <br /> --❑ 11 NfR VEHICLE No.to be permitted E%ENTAL HEALTH DIV. <br /> FITILIZER VEHICLE No.to be permitted <br /> - LIMITED WASTE HAULER VEHICLE No.to be permitted <br /> ❑ LIMITED WASTE HAULER TRAILER No.to be permitted <br /> ❑ 20+YARD BINS,DUMPSTERS,Roll-off&Other Containers No.to be permitted <br /> I hereby certify that I have prepared this application and that to the best of my knowledge it is true and correct. <br /> APPLICANT'S SIGNATURE X Title Date <br /> FOR DEPARTMENT USE ONLY V�/M�ry <br /> Fee Is Due: IN ANNUALLY El PER UNIT 11 PER SITE 13 EACH 11 HOURLY 11 Jan.1&Received By Jan.31XOO July 1&Received By July 31 <br /> REMIT <br /> ASE EXPLANATION BILLING REMITTANCE $ AMOUNT DUE CHECKED <br /> DATE DATE REMITTED AMOUNT <br /> FEE $500.00 81/82 7-1-81 7-31-81 $500.00 X <br /> FEE <br /> LESS <br /> PRORATION <br /> PPLUS <br /> ENALTY n'IVIILIIBE ADD D AFTER DUE DATE SHOW BELOW <br /> -505 of BAS <br /> OTHER 60 DAYS-250/0 of BAS: FEE <br /> OTHER 90 DAYS- O BAS FEE <br /> Yn�z_ <br /> Received by Dae Receipt No. Permit Nos. 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 /> L <br />