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Applicatlon"'I Be rued When Properly Completed.Be Sun To S nThe lication. <br /> Ird <br /> PLICATION FOR INSPECTION <br /> BON NECESSARY AND NON TRANSFERABLE,REVOCABLE,AND SUSPENDABLE '� /SOLID WASTE <br /> ENVIRONMENTAL HEALTH PERMITjl" �r <br /> T.� SOLID WASTE .,......... <br /> Application is hereby made to carry on business under Permit in the jurisdiction area of San Joaquin Local Health District. <br /> O Business Name(DBA) Corral Hollow Landfill Address Corral- Hollow RdTracy <br /> =owner Ci tv of Tracv Address P. 0. Box 1029. Tracy 95376 <br /> J Firm Partners,Addresses and Telephone Numbers <br /> IOL' Business Telephone No. Emergency Telephone No. <br /> Franchise Area Served <br /> �Applicants Name(Print) Title Date <br /> Please check Applicable Category(s).Fill In the Required Information,Return all 3 copies. <br /> 11 SOLID WASTE DISPOSAL SITE,NO.39-AA- <br /> 11 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 <br /> ❑ SITE EXEMPTION APPLICATION <br /> VEHICLES AND CONTAINERS(Fill Supplemental Form) <br /> ❑ COMPACTOR TRUCK No.to be permitted <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,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 1 have prepared this application and that to the best of my knowledge it is true and correct. <br /> APPLICANT'S SIGNATURE X Title Date <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due: L°9 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 /> A DATE DATE REMITTED AMOUNT <br /> FEE $500.00 1 yr. $500.00 x <br /> j FEE - <br />!I LESS <br /> R PRORATION <br /> PLUS <br /> PENALTY <br /> j� OTHER <br /> t <br /> OTHER <br /> Received by Date 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 21109 STOCKTON.CA 95201 <br />