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t <br /> Appif 41111111111 1 Processed When Properly Completed.Be Sure To Sig AppMeatlon. <br /> APPLICATION FOR INSPECTIO <br /> NO CARBON NECESSARY AND N N-TRANSFERABLE, REVOCABLE,AND SPENDABLE SOLID WASTE <br /> ENVIRONMENTAL HEALTH PERMIT <br /> SOLID WASTE <br /> Application is hereby ma <br /> ,FBusiness Name(DBA) Commerce a� Salvage Address 2435 E. Heber Ave. , Stockton <br /> Address <br /> z Owner <br /> Commercial Salvace 2435 E. Heber Ave. , Stockton, CA 95205 <br /> r � <br /> J Firm Partners,Addresses and Telephone Numbers rm ®ry & ��f- C�orc�er�� lli ve y7$-3077 �c>//I/e[so.�/ /9/,fi�ehj <br /> aBusiness Telephone No. y�3 — 9 qoh Emergency Telephone No. �/7�q-30 `77 35'd9S6 <br /> Franchise Area Served <br /> 1= Pde�,,- �'. IVe/Srj, Dyes df'ti� Date <br /> Applicants Name(Print) r Title / <br /> Please 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 <br /> ® SOLID WASTE TRANSFER STATION <br /> ❑ INDUSTRIAL WASTE GENERATOR <br /> ❑ STATIONARY COMPACTOR(20 yd.or greater) <br /> ❑ HAZARDOUS WASTE GENERATOR <br /> ❑ INFECTIOUS WASTE GENERATOR <br /> ❑ WASTE STORAGE FACILITY <br /> ❑ NEW SITE APPLICATION FEE <br /> ❑ MIXED WASTE RECYCLING FACILITY <br /> ❑ MANURE STORAGE SITE <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 <br /> (No. to be used dually as Limited Waste Hauler Vehicle) - - - - - - - - - - - - - <br /> 11 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 ation at a best f knowledge it is true and correct. <br /> APPLICANT'S SIGNATURE ` ��®"- --!�- Date <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due:'7 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 i DATE REMITTED AMOUNT <br /> FEE $350.00 1980/81 7/24/80 8/15/80 _$350.00 X <br /> FEE <br /> LESS <br /> PRORATION <br /> PLUS <br /> PENALTY <br /> OTHER <br /> OTHER <br /> 6 7_ V J/L <br /> Received by Date Receipt No. Permit Nos. Issuance Date Mailed Delivered <br /> APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1001 E.HAZELTON AVE.,P.O.BOX 2009 STOCKTON,CA 95201- <br />