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Application 0a Processed When Properly Completed.Be Sure To SI <br /> EJ <br /> - APPLICATION FOR INSPECTION pp pp 1 <br /> NO CARBON NECESSARY AND NON TRANSFERABLE, REVOCABLE,AND SUSPENDAJLe 2 0 198 50LID WASTE <br /> ENVIRONMENTAL HEALTH PERMIT <br /> SOLID WASTE SAN jr)AQ9 IN L,Cr-AL <br /> HEALTH DISTRICT <br /> Application is hereby made to carry on business under Permit in the jurisdiction area of San Joaquin Local Health District. <br /> OF Business Name(DBA) Ci t_Y Of Ripon Address 311 W. 1St St. , Ripon <br /> i Owner SA L Address A M <br /> c <br /> u Firm Partners,Addresses and Tele hone Numbers <br /> aBusiness Telephone No. 2c'!>>_'e2%`% — ` �0 g Emergency Telephone No. <br /> Franchise Area Served 61 O F Kt G <br /> L Applicants Name(Print) -kc Title(- 'ry d�.yr r+ Date �� 7- <br /> Please <br /> Please check Applicable Category(s).Fill in the Required Information,Return all 3 copies. <br /> ❑ SOLID WASTE DISPOSAL SITE,NO.39-AA- <br /> El NEW SITE PERMIT <br /> ❑ SOLID WASTE TRANSFER STATION <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 <br /> ❑ MANURE STORAGE SITE 1✓��' G � o C'1/ <br /> ❑ SITE EXEMPTION APPLICATION <br /> VEHICLES AND CONTAINERS(Fill Supplemental Form) <br /> COMPACTOR TRUCK No.to be permitted .2�* <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,DUMPSTERS,Roll-off&Other Containers No.to be permitted <br /> I hereby certify that I have prepar d th' pplication and that t t6e best of my knowledge it is true and correct. <br /> APPLICANT'S SIGNATURE y _Title �� �'�� Date V',(7 -97 <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 <br /> FEE <br /> LESS <br /> PRORATION <br /> PLUS <br /> PENALTY <br /> OTHER <br /> OTHER <br /> Received by Date Receipt No. Permit Nos. Issuance Date Mailed Delivered <br /> APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1501 E.HAZELTON AVE.,P.O.BOX 2009 STOCKTON,CA 95201 <br />