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Appiicatio I Be Processed When Properly Completed.Be Sure To Sign The Application. <br /> � <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 /> OF Business Name(DBA) Commercial Salvage Address-2435 EWeber Ave. , Stockton <br /> i Owner CQmmerci al Salvage Address same <br /> .� lA' s/,�„ Y 20 fMa1Ne/say/ /9�Ss�yaelo v Goa/< <br /> J Firm Partners,Addresses and Telephone NumbersP iv, ®ccv�i✓� �2�'�O�d°�.n 1�--%� 3 p <br /> 0E Business Telephone No.— =g��-� Emergency Telephone No. "179 -_?e;717 <br /> Franchise Area Served <br /> L Applicants Name(Print) Title Se- Date �Please check check Applicable Category(s).Fill In the Required Information,Return all 3 copies. <br /> ❑ SOLID WASTE DISPOSAL SITE,NO.39-AA- �� <br /> ❑ NEW SITE PERMIT 5 <br /> XX,XX SOLID WASTE TRANSFER STATION S <br /> ❑ INDUSTRIAL WASTE GENERATOR Q�" `5& <br /> ❑ STATIONARY COMPACTOR(20 yd.or greater) <br /> ❑ HAZARDOUS WASTE GENERATOR <br /> ❑ INFECTIOUS WASTE GENERATOR <br /> ❑ WASTE STORAGE FACILITY <br /> ❑ NEW SITE APPLICATION FEEO15 <br /> 1:1MIXED WASTE RECYCLING FACILITY Q3�� <br /> ❑ MANURE STORAGE SITE <br /> ❑ SITE EXEMPTION APPLICATION ` <br /> VEHICLES AND CONTAINERS(Fill Supplementfj+ ro m) <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 <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 thi plication and th t to he best of my knowledge it is true and correct. <br /> 01 <br /> APPLICANT'S SIGNATURE X ���Itle Date <br /> 10, <br /> FOR DEPARTMENT USE ONLY yy.��/ <br /> Fee Is Due: ANNUALLY C3 PER UNIT 11 PER SITE El EACH 11 HOURLY 11 Jan.1&Received By Jan.31 ,MJuly 1&Received By July 31 <br /> REMIT <br /> BASE EXPLANATION BILLING REMITTANCE $ AMOUNT DUE CHECKED <br /> DATE DATE REMITTED AMOUNT <br /> FEE $350.00 81/82 7-1-81 -Due 7-31-81 $350.00 X <br /> FEE <br /> LESS <br /> PRORATION <br /> PLUS PENALTr <br /> PENALTY /� WNBELOW <br /> " <br /> OTHER 30 DAYS- �/�"n i "Alit ITE <br /> - :);b o BASE FEE <br /> OTHER 90 DAYS-. <br /> Received by Date 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 />