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Application rocessed When Properly Completed.Be Sure To Sl pplication. <br /> APPLICATION FOR INSPECTION <br /> r NO CARBON NECESSARY AND NON-TRANSFERABLE, REVOCABLE,AND SLISPENDABLE 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 /> H Business Name(DBA) California Waste Removal/Sani tary Ci"ress 1333 E. Turner Rd. , Lodi <br /> owner David Vaccareaaa Address P • 0. Box 319 , Lodi , CA 95241 <br /> Y Firm Partners,Addresses aj d Tele hone Numbers Annette V M u r d a c a , P O Box 319 , L o d i , CA 95241 <br /> Go' Business Telephone No. l 209 369-8274 Emergency Telephone No.=_369—U74 <br /> Franchise Area Served <br /> L Applicants Name(Print) David V a c c a r e z z a Title President Date 2.12 8/8 9 <br /> Please check Applicable Category(s).Fill in the Required Information,Return all 3 copies. <br /> ❑ SOLID WASTE DISPOSAL SITE,NO.39-AA- RECEIVED <br /> ❑ NEW SITE PERMIT JAN 9 1989 <br /> ❑ SOLID WASTE TRANSFER STATION <br /> ❑ INDUSTRIAL WASTE GENERATOR Ans.lU............ <br /> 1:1 STATIONARY COMPACTOR(20 yd.or greater) R <br /> ❑ HAZARDOUS WASTE GENERATOR <br /> ❑ INFECTIOUS WASTE GENERATOR <br /> ❑ WASTE STORAGE FACILITY t � G <br /> ❑ NEW SITE APPLICATION FEE 4�"C, <br /> ❑ MIXED WASTE RECYCLING FACILITY <br /> ❑ MANURE STORAGE SITE tai Q <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 /> RENDERING, <br /> - - - - - - - - - - - - <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, DUMPSTE ,Roll-off&Other Containers No.to be permitted <br /> I hereby certify that I have prepared lic ti nd at to the best of my knowledge it is true and correct. <br /> APPLICANT'S SIGNATURE X Title President Date 2/28/89 <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due: ❑ 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 /> pp //�� DATE DATE REMITTED p �/AMOUNT <br /> 8 <br /> FEE unitsl. 1/5/89 00.00 X <br /> $10 ea <br /> FEE <br /> LESS <br /> PRORATION j� <br /> PPLUS <br /> ENALTY DAYS FROM BILLING DATE. <br /> OTHER <br /> OTHER <br /> -1 -k�l Ca lZ O 1 u 1� a L� cYLD <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 />