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APPLICATION +' - <br /> 4. > 9 (For Non-Transferable, Revocable, and Suspendable) j'f <br /> ` - ENVIRONMENTAL HEALTH PERMIT /U,11� SEPTAGE <br /> LIQUID WASTE <br /> Application i hereby made to carry on business in the jurisdictional area of the San Joaquin Local Health District <br /> rn Business Name (DBA) — Address <br /> Owner Address <br /> Firm Partners, Addresses and Telephone Numbers <br /> IL Business Telephone No. - Emergency Telephone No. — -- —L <br /> �Contractor Licence No. <br /> L Applicants Name (Print) __ Title Date <br /> Please check Applicable Category(1-7)and Fill In the Required Information <br /> 1~❑ PUMPER VEHICLE_PERMIT REGISTRATION (FOR EACH VEHICLE) <br /> —14 0W <br /> For July 1, - June 30, 19 Disposal Sites -- <br /> Description(Make/Yr., Color) - - <br /> Serial No. _CAL. License No. CAL. License Renewal No. - <br /> Capacity_ Gal., Weights & Measures No— <br /> Equipment <br /> - <br /> Equipment Parking Address <br /> 2. ❑ PUMPER YARD <br /> For July 1, June 30, 19 <br /> No. of Vehicles Stored <br /> No. of Chemical Toilets Stored <br /> 3. ❑ PERCOLATIONTEST 7 „ -7 x <br /> R.S. or R.C.E. Name-- - ` or�ReC: <br />