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Application Processed When Properly Completed.Be Sure To SI Application. <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 carry on business under Permit in the jurisdiction area of San Joaquin Local Health District. <br /> to Business Name(DBA) Address <br /> Owner independent Di Szno5a 1 Service Addressil 9655 ElGrove Florin Rd #5, Elk Grove <br /> Firm Partners,Addresses and Telephone Numbers Eugene Jo & Rose Marie Pinasco 9467 Sara Street — Elk Grove <br /> a Business Telephone No. 19 6-685-4061 6-08"S'-Elf? 63Pz AAmergency Telephone No. 916-687-6646 <br /> J Franchise Area Served Area #1 <br /> �Applicants Name(Print) Imam A. Pinasco Title Sec/Treas. Date 7/17/81 <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) Q� 4 <br /> 11HAZARDOUS WASTE GENERATOR / !s, <br /> ❑ INFECTIOUS WASTE GENERATOR Q <br /> ❑ WASTE STORAGE FACILITY �'0 <br /> ❑ NEW SITE APPLICATION FEE <br /> ❑ MIXED WASTE RECYCLING FACILITYR�' <br /> 11vjMANURE STORAGE SITE <br /> 11SITE EXEMPTION APPLICATION01 <br /> VEHICLES AND CONTAINERS(Fill Supplemental Form) ,`' re COMPI TTT� ,_ No.to be permCOLLECTION TRUCK No.to be permitRROLL-OFF TRACTORNo.to be permitROLL-OFF TRAILER No.to be permitteA 1 <br /> ❑ b <br /> RENDERINGVEHIC e used dEally as Limited Waste Hauler Vehicle) No.to be permitted ��N HE�TH DIST <br /> �T• <br /> ❑ MANUER VEHICLE No.to be permitted ENtA�NE�TH D <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 prepay his apjca ' ' 4nd that to the best of my knowledge it is tr and correct. <br /> APPLICANT'S SIGNATURE X (/,(j � Title 9 Date r' <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 /> DATE DATE REMITTED AMOUNT <br /> FEE $30.00 81/82 7/10/81 Due 8_/10/81 $30.00 X <br /> FEE <br /> LESS <br /> PRORATION <br /> DATE 5HOWN <br /> PLUS 30 DAYS-5073 of BASE FEE BELOW <br /> PENALTY <br /> OTHER DAYS-25 jo of BASE FEE <br /> OTHER <br /> Received by Date Receipt No. Permit Nos. Issuance Date Mai d Delivere <br /> APP TURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1601 E.HAZELTON AVE.,P.O.BOX 2009 STOCKTON,CA 95201 <br />