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r . Applicatlon II Bussed When Properly Completed.Be Sure To Sign The ation. <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 carron business under Permit in the jurisdiction area of San Joaquin Local Health District. <br /> y Business Name(DBA) Commercial Sail vage Address 2435 E. Weber Ave., Stockton <br /> QOwner Commercial Salvage Address 2435 E. Weber Ave. , Stockton 95205 <br /> j Firm Partners,Addresses and Telephone Numbers <br /> aBusiness Telephone No. 3- G Emergency Telephone No. <br /> Franchise Area Served <br /> �Applicants Name(Print) r!/?n7-,9Y W, Pa A)YAA' Title S e c- Date // ;2o- 7g <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 /> Q SOLID WASTE TRANSFER STATION <br /> ❑ INDUSTRIAL WASTE GENERATOR <br /> ❑ STATIONARY COMPACTOR(20 yd.or greater) <br /> ❑ HAZARDOUS WASTE GENERATOR <br /> ❑ INFECTIOUS WASTE GENERATOR FEE 19 jggQ <br /> ❑ WASTE STORAGE FACILITY <br /> ❑ NEW SITE APPLICATION FEE ENVIROMENTAL HEALTH <br /> ❑ MIXED WASTE RECYCLING FACILITY �FERMIT/SERVICE$ <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 th'' pplication an t to the best of my knowledge it is true and correct. C,/ <br /> APPLICANT'S SIGNATURE X Title Jam- /E��Lelca/• Date fS_b <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due: IX 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 $350.00 1 yr. $350.00 X <br /> FEE <br /> LESS <br /> PRORATION <br /> PLUS <br /> PENALTY <br /> OTHER <br /> OTHER <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 /> e <br />