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ApplicationBe Processed When Properly Completed.Be Sure To Si0e Application. <br /> - APPLICATION FOR INSPECTION <br /> NO CARBON NECESSARY AND NON-TRANSFERABLE, REVOCABLE,AND SUSPENDABLE SOLID WASTE <br /> ENVIRONMENTAL HEALTH PERMIT <br /> - SOLID WASTE <br /> Application is hereby made to carry on business under Permit in the jurisdiction area of San Joaquin Local Health District. <br /> H Business Name(DBA) Corral Hollow Rd. Landfill Address Corral Hollow Road <br /> Owner City of Tracy Address P.O. Box 1029, Traci 95376 <br /> 9 Firm Partners,Addresses and Telephone Numbers <br /> a Business Telephone No. Emergency Telephone No. <br /> Franchise Area Served <br /> L Applicants Name(Print) Title Date <br /> Please check Applicable Category(s).Fill in the Required Information,Return all 3 copies. O� <br /> 5� <br /> XX13X SOLID WASTE DISPOSAL SITE,NO.39-AA- 005 OP�` <br /> ❑ NEW SITE PERMIT Y <br /> ❑ SOLID WASTE TRANSFER STATION J� <br /> USTRIAL WASTE <br /> ❑ STDCOMP COMPACTOR 20GENERATOR <br /> ATIIONARyd.or greater) <br /> ❑ HAZARDOUS WASTE GENERATOR <br /> \0 <br /> El ` Obj" <br /> INFECTIOUS WASTE GENERATOR �\G� �� .b <br /> ❑ WASTE STORAGE FACILITY <br /> ❑ NEW SITE APPLICATION FEE //```,`� P Q�5 <br /> 1:1 MIXED WASTE RECYCLING FACILITY 40 0&I <br /> 1:1 MANURE STORAGE SITE a� <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(No. to be used dually as Limited Waste Hauler Vehicle) - <br /> ❑ RENDERING,VEHICLE N . <br /> 1:1MANUER VEHICLE N e permitted��Q <br /> C1 FERTILIZER VEHICLE No.to be p Itt <br /> ❑ LIMITED WASTE HAULER VEHICLE No.to be permitted <br /> ❑ LIMITED WASTE HAULER TRAILER No to�b�e` <br /> per <br /> mit'tendr <br /> ❑ 20+YARD BINS, DUMPSTERS,Roll-off&Other Containers 1441 7� tt 'I'L HEALTFI DIST. <br /> ENVI ,0NMENTAL ,iEALTH DIV. <br /> I hereby certify that I 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 ��//yy.,, <br /> Fee Is Due: ANNUALLY 11 PER UNIT ❑ PER SITE E-] EACH 11 HOURLY ❑ Jan.1&Received By Jan.31XXI July 1&Received By July 31 <br /> REMIT <br /> BASE EXPLANATION BILLING REMITTANCE $ AMOUNT DUE CHECKED <br /> DATE _ DATE REMITTED AMOUNT <br /> FEE $500.00 81/82 7-1-81 Due 7-31-131 $500.00 X <br /> FEE <br /> LESS <br /> PRORATION <br /> PLUS <br /> PENALTY WILL LL BE ADDED AFTER DUE DATE SHOWN BELOW <br /> OTHER 30 DAYS 76 of BASE FEE <br /> An nAVC <br /> OTHER 90 DAYS- 5% of BASE FEE <br /> Received by L 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 />