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y <br /> w <br /> APPLICATION <br /> SAN JOAQUIN COUNTY REFUSE COLLECTOR'S LICENSE <br /> THIS APPLICATION MUST BE ACCOMPANIED BY A CASHIER'S CHECK OR IRREVOCABLE <br /> LETTER OF 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 Phone <br /> Home Address <br /> (Address) (City) (Zip Code) <br /> 4. Comity Business License Number <br /> I hereby certify under penalty of perjury that the above information is true 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 /> 4. 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 /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1. Received by Date <br /> 2. Applicant has the ability to comply with all applicable County regulations and ordinances and State Law. <br /> ( ] Yes [ ] No <br /> 3. Reviewed and recommended for approval by: <br /> ---------------------------------------------- <br /> BOARD OF SUPERVISORS <br /> COUNTY OF SAN JOAQUIN,STATE OF CALIFORNIA <br /> B---- <br /> REFUSE <br /> - _REFUSE COLLECTOR'S LICENSE NO._ <br /> POST IN A CONSPICUOUS PLACE <br /> A license to collect recyclable materials within the 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 ordinances,rules and regulations and State law. This <br /> license is subject to revocation by this Board,is non-transferable,and is issued for an indefinite period of time. <br /> I hereby certify that the above Order as passed and adopted on by the following vote of the <br /> Board of Supervisors,to wit: <br /> AYES: <br /> NOES: <br /> ABSENT: <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 /> \Solid-wmte\edmin\Mike\Documents\SJ County Recuse Collector's License Application 0415-03.tvpd <br />