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Application&e Processed When Properly Completed.Be Sure To Site 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) California Clay Disposal Site Address 32( '-8. E1 Dorado St. , Stockton <br /> zOwner Cove Contractors AddressAtto Ron Strauss. P-0- Rpt 6510, Stockton <br /> j Firm Partners,Addresses and Telephone Numbers <br /> COL' Business Telephone No. 4' O -3 R Emergency Telephone No. <br /> Franchise Area Served <br /> Applicants Name(Print) ✓ Title �' *✓�a Date <br /> Please check Applicable Category(s).Fill In the Required Information,Return all 3 copies. <br /> MK SOLID WASTE DISPOSAL SITE,NO.39-AA- 010 <br /> ❑ NEW SITE PERMIT `, "I <br /> SOLID <br /> DUS RIIAL WASTE GENERATOR <br /> P'SS``O <br /> 1:1 I <br /> ❑ STATIONARY COMPACTOR(20 yd.or greater) <br /> ❑ HAZARDOUS WASTE GENERATOR <br /> El WASTE INFECTIOUS BTOR <br /> STORAGE FACILITY <br /> LPA\ <br /> ❑ NEW SITE APPLICATION FEE ,�QQ�\ �U )� <br /> ❑ MIXED WASTE RECYCLING FACILITY <br /> ❑ MANURE STORAGE SITE v��\ <br /> 13 SITE EXEMPTION APPLICATION \510J U L '1 ( 1981 <br /> F� <br /> VEHICLES AND CONTAINERS(Fill Supplemental Form) ENV1R('",E`,'I'AL HEALTH <br /> ❑ COMPACTOR TRUCK No.to be permitted F ERNI I/SERVICES <br /> ❑ COLLECTION TRUCK No.to be permitted <br /> ❑ ROLL-OFF TRACTOR No.to be permitted <br /> ❑ ROLL-OFF TRAILER No.to be permitted <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 icati d that a best of my knowledge it is true and correct. <br /> APPLICANT'S SIGNATURE X r� Title � � /1 Date' 641 <br /> ,,yy�r <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due: IX ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ HOURLY ❑ Jan.1&Received By Jan.31 )a July 1&Received By July 31 <br /> REMIT <br /> BASE EXPLANATION BILLING REMITTANCE $ AMOUNT"DUE CHECKED <br /> DATE DATE REMITTED AMOUNT <br /> FEE $500.00 ;81/82 7-1-81 7-3181 $500.00 - X <br /> FEE <br /> LESS <br /> PRORATION - — — - -- — - - <br /> PLUS <br /> DAYS PENALTY0% f BASE EE <br /> OTHER 60 DAYS- 5% of BASE IEE <br /> OTHER <br /> ff� 'V� -712 �_b q <br /> Received by Date Receipt No. Permit Nos. Issuance Date Mailed Delivered <br /> APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1501 E.HAZELTON AVE.,P.O.BOX 2009 STOCKTON,CA 95201 <br />