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i <br /> Applica a Processed When Properly Completed.Be Sure T" Application. <br /> APPLICATION VOR INSPECT;. <br /> - NO caReoN N'*CESSARY AND NON-TRANSFERABLE, REVOCABLE,AND SLISPENDABLE 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 /> rnBusiness Name(DBA) Foothill Landfill Address Waverly Rd. , Linden <br /> z Owner Foothill Sanitary Landfill , I ncAddress <br /> P.O. Box 1461, Stockton 95201 <br /> 9 <br /> j 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,Retum all 3 copies. <br /> XJ3X SOLID WASTE DISPOSAL SITE,NO.39-AA- 004 <br /> El <br /> SITE PERMIT <br /> 1:1 SOLID M <br /> ID WASTETRANSFER STATION QJ�QQ` <br /> ❑ INDUSTRIAL WASTE GENERATOR da� <br /> ❑ STATIONARY COMPACTOR(20 yd.or greater) �s� <br /> ❑ HAZARDOUS WASTE GENERATOR <br /> ❑ INFECTIOUS WASTE GENERATOR ��1.► .� • <br /> 1:1WASTE STORAGE FACILITY ko�� ��4 �Q4Q bb�b1 <br /> 1:3 NEW � <br /> NEW SITE APPLICATION FEE (�i % '� 041-k <br /> MIXED WASTE RECYCLING FACILITY S� / <br /> 11 � <br /> ❑ MANURE STORAGE SITES \S4J <br /> ❑ SITE EXEMPTION APPLICATION <br /> VEHICLES AND CONTAINERS(Fill Supplemental Form) <br /> ❑ COMPACTOR TRUCK No.to be permitt <br /> ❑ COLLECTION TRUCK No.to be permitte <br /> ❑ ROLL-OFF TRACTOR No.to be permitte <br /> 11ROLL-OFFTRAILER No.to be permitter !J 1931 <br /> (No. to be used dually as Limited Waste Hauler Vehicle) - - - - - - - - - - - - - LTH 1ST- <br /> 11 RENDERING,VEHICLE No.to be permitted <br /> etdCRL <br /> 1:1MANUER VEHICLE No.to be permittet7'A_��jal�{�A1.TH DN• <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 I have prepared t 'g application ar�lt#fat to the best of my knowledge it is tru and correct. <br /> APPLICANT'S SIGNATURE X 6" TitleDate <br /> i <br /> FOR DEPARTMENT USE ONLY <br /> Fee Is Due:A ANNUALLY ❑ PER UNIT ❑ PER SITE ❑ EACH ❑ HOURLY ❑ Jan.1&Received By Jan.31=Xluly 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 7-31-81. $500.00 X <br /> FEE <br /> LESS <br /> PRORATION PENAI <br /> PLUS IJV y s,y <br /> PENALTY DAYS i/° r• t.r - <br /> OTHER ,. "I � _ <br /> OTHER .. <br /> lm7 , <br /> Received by 6ate Receipt No. Permit Nos. Issuance Date Mailed Delivered <br /> t APPLICANT—RETURN ALL COPIES TO: ENVIRONMENTAL HEALTH PERMIT/SERVICES 1601 E HAZELTON AVE.,P.0.BOX 2009 STOCKTON,CA 95701 <br /> a <br />