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Applicatlor Be Processed When Properly Completed.Be Sure To S a Application. <br /> APPLICATION FOR INSPECTION <br /> NO CARBON NECESSARY AND NON-TRANSFERABLE, REVOCABLE,AND SUSPENDABLE SOLID WASTE " � <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 /> H Business Name(DBA) French Carin Si t`' Address >�tithey Rd. A 15 <br /> z Owner Address <br /> a <br /> J Firm Partners,Addresses and Telephone Numbers -17 x <br /> It Business Telephone No. Emergency Telephone No. Tj k ' c <br /> 9 k-- <br /> Franchise Area Served <br /> �Applicants Name(Print) City of Stockton Title Date <br /> Please check Applicable Category(s).Fill in the Required Information,Return all 3 copies. <br /> { SOLID WASTE DISPOSAL SITE,NO.39-AA- g` <br /> ❑ NEW SITE PERMIT <br /> ❑ SOLID WASTE TRANSFER STATION <br /> ❑ INDUSTRIAL WASTE GENERATOR <br /> ❑ STATIONARY COMPACTOR(20 yd.or greater) <br /> F <br /> ❑ HAZARDOUS WASTE GENERATOR ;k <br /> ❑ INFECTIOUS WASTE GENERATOR " <br /> ❑ WASTE STORAGE FACILITY <br /> ❑ NEW SITE APPLICATION FEE <br /> ❑ MIXED WASTE RECYCLING FACILITY <br /> ❑ MANURE STORAGE SITE IA <br /> ❑ SITE EXEMPTION APPLICATION .=: <br /> VEHICLES AND CONTAINERS(Fill Supplemental Form) <br /> ❑ COMPACTOR TRUCK No.to be permitted <br /> ❑ COLLECTION TRUCK No.to be permitted } > <br /> ❑ ROLL-OFF TRACTOR No.to be permitted <br /> ❑ ROLL-OFF TRAILER No.to be permitted x <br /> (No. to be used dually as Limited Waste Hauler Vehicle) - - - - - - - - - - - - - <br /> ❑ RENDERING,VEHICLE No.to be permitted # <br /> ❑ MANUER VEHICLE No.to be permitted <br /> ❑ FERTILIZER 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. r a <br /> APPLICANT'S SIGNATURE X Title Date , <br />` FOR DEPARTMENT USE ONLY y <br /> Fee Is Due: ❑ ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ HOURLY ❑ Jan.1&Received By Jan.31 ❑ July 1&Received By July 31 <br /> REMIT <br /> BASE EXPLANATION BILLING REMITTANCE $ AMOUNT DUE CHECKED <br /> DATE DATE REMITTED AMOUNT <br /> FEE $500.09 80-81 7-24-80 Due 3-15-90 <br /> FEE <br /> LESS <br /> ! 1a3 1)50.00 50°' -19- ' Due -1`i $750.00 X <br /> PLUS <br /> PENALTY <br /> OTHER <br /> OTHER <br /> rya <br /> 'x Received by ate Receipt No.. Permit Nos Issuance Date x Mailed Delivered ¢ <br /> APPLICANT—RETURN ALL COPIES TO ENVIRONMENTAL HEALTH PERMIT/SERVICES 1601 E.HAZELTON AVE.,P.O.BOX 2009 STOCKTON,CA 95201 <br />