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APPLICATION <br /> COLLECTCHEC <br /> SAN JOA )UIN COUNTY R--E—FUSFK OREIRREVOCABLE <br /> TMSAPPLICATION MUST BE ACCOMPANIECASHIER'S <br /> LETTER OF CREDIT IN THE AMOUNT OF$20,600". (Please print or type.) <br /> (209) 599-8670 <br /> 1. Business Name Roos Disposal, Inc. Phone-- <br /> Road Ripon 95366 <br /> 2. Business Address 38 Frontage (Zip Code) <br /> (Address) (City). <br /> Eric A. Winters I rs Phone (209) 599-8670 <br /> 3. Owner(s)Name <br /> Home Address 23313 Highland Road Ripon 95366 ode) <br /> (Address) (City) <br /> ounBusiness License Number (City of Ripon Business License - 0200002594) <br /> 4. Cty <br /> 1 hereby certify under penalty of perjury that the above infon-nation is true and correct to the best of my knowledge and belief <br /> Dated 11/24/03 DZi�sllrGjNkU�MREOF�LICENSEE MR AGENT <br /> FOR COUNTY USE ONLY <br /> DEPARTMENT OF PUBLIC WORKS <br /> Dat <br /> I Received by <br /> Yes [ NO <br /> 2. Deposit/Letter of Credit received. <br /> 3. Applicant holds current County Business License. Yes [ NO <br /> 4. Applicant has submitted proof of adequate Workers'Compensation and [.X] Yes I NO <br /> Casualty Insurance. [X] Yes No <br /> Applicant has submitted required financial stateme <br /> 6. Reviewed and recommended for approval by: <br /> FOR COUNTY USE ONLY <br /> ENvIRONMENTAL HEALTH DEPARTMENT <br /> Date_ 15-03 <br /> Received by <br /> 2. Applicant has the ability to comply with all applicable County regulations and ordinances an4 YesState Law. <br /> N4 - No <br /> 3. Reviewed and recommended for approval by: <br />