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i Application Processed Witten Properly Completed.Be Sure To Sl pplicatlon. <br /> APPLICATION FOR INSPECTION <br /> NO CARBON NECESSARY AND NON-TRANSFERABLE, REVOCABLE,AND SUSPENDABLE <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) Commercial Salvage Address 2435 Weber, St9Ckton <br /> c Owner Egm,err-.ia—_Salvage Address 243S F. W b r, Stockton <br /> Firm Partners,Addresses and Telephone Numbers <br /> Business Telephone No. Emergency Telephone No. <br /> Franchise Area Served <br /> L Applicants Name(Print) Title Date <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 �O <br /> ❑ INDUSTRIAL WASTE GENERATOR <br /> ❑ STATIONARY COMPACTOR(20 yd.or greater) <br /> ❑ HAZARDOUS WASTE GENERATOR <br /> ❑ INFECTIOUS WASTE GENERATOR <br /> ❑ WASTE STORAGE FACILITY <br /> ❑ NEW SITE APPLICATION FEE <br /> ❑ MIXED WASTE RECYCLING FACILITY 2, <br /> 1:1 MANURE STORAGE SITE <br /> ❑ SITE EXEMPTION APPLICATION O�F. <br /> VEHICLES AND CONTAINERS(Fill Supplemental` orm) <br /> C� COMPAQJQB TRI IGK No.to be permitted <br /> Ll COLLECTION TRUCK No.to be permitted <br /> 13 ROLL-OFF TRACTOR No.to be permitted 7 <br /> 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, DUMPSTERS,Roll-off&Other Containers No.to be permitted <br /> I hereby certify that I have d thi p ication and the best of m nowledge it is e and corEpct, / <br /> APPLICANT'S SIGNA U X Title L Date <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 80,00 81/82 11/5/81 Due 12/5/81 $80.00 X <br /> FEE <br /> LESS <br /> PRORATION <br /> PLUS PENALTIES A 111.#._ BE ADMD AFTER WE DATE SHOWN SLOW <br /> PENALTY <br /> 30 DAYS- <br /> FEE <br /> OTHER 60 DAYS= a�' of BASE FEE <br /> � <br /> OTHER AYS,• ` of 0AS1 ,iG <br /> Received by Date l 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 />