WASTE HAULER - FOOD GREASE TRAPPERS INC of ,
Tel. Fax.
HAULER HEALTH PERMIT
Permit#
SH-16-1 License For : Waste Hauler
Date of Print
8/11/2016 Granted To: Food Grease Trappers
Permit Issued Address: P.O. Box 2422 (111quebec) Lowell MA 01851
1/1/2016
Permit Expires Location of Establishment:
12/31/2016
Restrictions: Reg # R49182
Permit Fee Limited to grease pick up only
$105.00
Notes:
Late Fee
$0.00
This permit or license is granted in conformity with the statues and ordinances relating thereto, and expires on 12/31/2016 , unless
sooner revoked or suspended.
Larry Ramdin, MPH, REHS, CHO
Health Agent
• CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4`"FLOOR PUt11iCH@alth
Prevent,Promote.Protect.
TEL. (978) 741-1800 FAx(978) 745-0343
KIMBERLEY DRISCOLL Iramdin@salem.com
MAYOR LARRY RAMDIN,RS/RF FIS,CI-IO,CP-FS
H13AF:fI-I AGI NT
APPLICATION FOR A PERMIT TO TRANSPORT OFFENSIVE SUBSTANCES
,1
FEE: $105 Per Vehicle payable to the City of Salem No Cash
Name of Applicant: Cary YJO_men
Addrcss: 32ptqentat weu MA Qtg t Tel#:q-18 -373-3058
Name of Company: Fbo o n�' Q� `� W 7 �c
Address:�•O• t O)e WgZv;u JUOL4J60 M& 012CD l Tel#:
Email Address LED CRooMnenPA x k� 5• ('P')1^'1
s
Type of Vehicle R)r(l- 5nO
Gross Weight_�b=�
Reg.# M?1q�0 Year of Make: Wo
Substance(s)Hauled WQste VextpO1e 0 anc! Greer \rQt�) WQro�t
Route of Travel "1to W_Eo 001 C ie.J I n re-)
(must be completed)
Schedule of Travel ��rnitl 5
I HAVE READ THE BOARD OF HEALTH REGULATIONS,"RULES AND REGULATIONS FOR TRANSPORTIING OFFENSIVE
SUBSTANCES." I HAVE HAD THE OPPORTUNITY TO ASK QUESTIONS REGARDING THOSE REGULATIONS. I
UNDERSTAND THEM;AGREE TO ABIDE BY THEM AND UNDERSTAN THAT FAILURE TO DO SO MAY RESULT IN,
REVOCATION OF MY PERMIT TO CARRY OFFENSIVE SUBSTANCES.
PURSUANT TO HGL C62C, S49A I CERTIFY UNDER THE PENALITIES OF PERJURY THAT I,TO MY BEST KNOWLEDGE AND
BELIEF,HAVE FILED ALL STATE TAX RETURNS AND PAID ALL STATE TAXES REQUIRED UNDER THE LAW.
00— i2-ILOS Wc")- 43(Do
Signature Date SS#or Federal ID#
-------------------- ------------------------- .--- ------------------- ---------:---------- --------------------------
Permit# Check kylc� Check DaterjA—,� _
Updated 1120/13 1961
City of Salem, Massachusetts
Board of Health .,
120 Washington Street, 4th Floor, Salem, MA 01970 PubticHeatth
Kimberley Driscoll Tel. (978) 741-1800 Fax. (978) 745-0343 Larry Ramdin, MPH, REHS, CHO
Mayor Iramdin@salem.com Health Agent
HAULER HEALTH PERMIT
Permit#
SH-15-1 License For : Waste Hauler
Date of Print
3/17/2015 Granted To: Food Grease Trappers
Permit Issued
1/1/2015 Address: P.O. Box 2422 Lowell MA 01851
(111 quebec)
Permit Expires
12/31/2015 Location of Establishment:
Permit Fee
$105.00
Restrictions: Reg # R49182
Limited to grease pick up only
Late Fee
$0.00
Notes:
This permit or license is granted in conformity with the statues and ordinances relating thereto, and expires on 12/31/2015 , unless
sooner revoked or suspended.
a CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET,4T"FLOOR
TEL. (978) 741-1800
KIMBERLEY DRISCOLL FAX(978) 745-0343
MAYOR LRAIVIDIN([I�.SAI.EM.COM
LARRY RAmDIN,RS/RP:HS,CHO,CP-15
HLALTf I AG ENT
2011 APPLICATION FOR A PERMIT TO TRANSPORT OFFENSIVE SUBSTANCES
( FEE: $105 Per Vehicle payable to the City of Salem No Cash
Name of Applicant: \7 aX 0,A W U Y (ET)
Address: I &U b ( q I�V4- l l, M(A C) I P)S I Tel#: q10- 34_3- 3055
055
Name of Company: VOW GVt CL SC TY UKX S IN(,.
Address: ?b 6u I by ? n, MR nI BS I Tel#: Q—] n 3-B - 3D56
Type of Vehicle I S U 7 U
Gross Weight
lI
Reg.# Year of Make: 0 b
Substance(s)Hauled Vr�QS�
Route of Travel
(must be completed)
Schedule of Travel
I HAVE READ THE BOARD OF HEALTH REGULATIONS,"RULES AND REGULATIONS FOR TRANSPORTIING OFFENSIVE
SUBSTANCES."I HAVE HAD THE OPPORTUNITY TO ASK QUESTIONS REGARDING THOSE REGULATIONS. I
UNDERSTAND THEM;AGREE TO ABIDE BY THEM AND UNDERSTAN THAT FAILURE TO DO SO MAY RESULT IN
REVOCATION OF MY PERMIT TO CARRY OFFENSIVE SUBSTANCES.
PURSUANT TO HGL C62C,S49A I CERTIFY UNDER THE PENALITIES OF PERJURY THAT I, TO MY BEST KNOWLEDGE AND
BELIEF,HAVE FILED ALL STATE TAX RETURNS AND PAID ALL STATE TAXES REQUIRED UNDER THE LAW.
a, I (o ]1 `A S- U,4D02 a.10
Si tore Date SS#or Federal H)#
Permit# Check# /✓�/ Check Date f
Updated 5/23/11