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9 e <br /> APPLICATION <br /> SAN JOAQUIN COUNTY RECYCLING LICENSE <br /> 'S APPLICATION, MUST BE ACCOMPANIED BY A CASHIER'S CHECK OR IRREVOCABLE LETTER <br /> —CREDIT IN THE AMOUNT OF $20, 000. (Please print or type. ) <br /> 1. Business Name Phone <br /> 2. Business Address <br /> (Address) (City) (Zip Code) <br /> 3 . Owner(s) ' Name Home Address <br /> Phone <br /> 4. County Business License Number <br /> I hereby certify under penalty of perjury that the above information is true <br /> and correct to the best of my knowledge and belief. <br /> Dated <br /> SIGNATURE OF LICENSEE OR AGENT <br /> FOR COUNTY USE ONLY <br /> DEPARTMENT OF PUBLIC WORKS <br /> 1. Received by Date <br /> 2. Deposit/Letter of Credit received. [ ] Yes [ ] No <br /> 3 Applicant holds current County business license. [ ] Yes [ ] No <br /> Applicant has submitted proof of adequate Workers' Compensation and <br /> casualty insurance. [ ] Yes [ ] No <br /> 5. Applicant has submitted required financial statement. [ ] Yes [ ] No <br /> 6. Reviewed and recommended for approval by: • <br /> FOR COUNTY USE ONLY <br /> DEPARTMENT OF PUBLIC HEALTH <br /> 1. Received by Date <br /> 2. Applicant has the ability to comply with all applicable County regulations <br /> and ordinances and State law. [ ] Yes [ ] No <br /> 3. Reviewed and recommended for approval by: <br /> BOARD OF SUPERVISORS <br /> COUNTY OF SAN JOAQUIN, STATE OF CALIFORNIA <br /> B- <br /> REFUSE COLLECTOR'S LICENSE NO. <br /> POST IN A CONSPICUOUS PLACE <br /> A license to collect and transport commercial and industrial refuse within the <br /> unincorporated area of the County is hereby issued to <br /> This Board Order shall constitute such license. The licensee shall conduct its <br /> operations under the license in accordance with all applicable local <br /> ordinances, rules and regulations and State law. This license is subject to <br /> revocation by this Board, is non-transferable, and is issued for an indefinite <br /> Per Lod Gi tiztc. <br /> i hereby certify that the above Order as passed and adopted on <br /> by the following vote of the Board of Supervisors, to wit: <br /> AYES: <br /> NOES: <br /> t3—.ENT <br /> LOIS SAHYOUN, Clerk of the Board <br /> of Supervisors of the County of <br /> San Joaquin, State of California <br /> By (SEAL) <br /> Deputy Clerk <br />