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APPLICATION - <br /> SAN JOAQUIN COUNTY RECYCLING LICENSE <br /> 'S APPLICATION, MUST BE ACCOMPANIED BY A CASHIER'S CHECK OR IRREVOCABLE TETTER <br /> ..CREDIT IN THE AMOUNT OF $20, 000. (Please print or type. ) <br /> . Business Name Phone <br /> Business Address <br /> (Address) (City) (Zip Code) <br /> Owner(s) ' Name Home Address <br /> Phone <br /> County Business License Number <br /> hereby certify under penalty of perjury that the above information is true <br /> A correct to the best of my knowledge and belief. <br /> .ted <br /> SIGNATURE OF LICENSEE OR AGENT <br /> FOR COUNTY USE ONLY <br /> DEPARTMENT OF PUBLIC WORKS <br /> Received by Date <br /> Deposit/Letter of Credit received. [ ] Yes [ ] No <br /> Applicant holds current County business license. [ ] Yes [ ] No <br /> Applicant has submitted proof of adequate Workers' Compensation and <br /> casualty insurance. [ ] Yes [ ] No <br /> Applicant has submitted required financial statement. [ ] Yes [ ] No <br /> Reviewed and recommended for approval y: <br /> ------------------------- <br /> FOR COUNTY USE ONLY <br /> DEPARTMENT OF PUBLIC HEALTH <br /> Received by Date <br /> Applicant has the ability to comply with all applicable County regulations <br /> and ordinances and State law. [ ] Yes [ ] No <br />