Laserfiche WebLink
1 - <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ' F-NI VIRONMENTAL HEALTH DIVISION <br /> 445 N. SAN JOAQUIN STREET, P.O. BOX 2009 <br /> STOCKTON, CA 95201 <br /> ' (209) 468-3420 <br /> APPLICATION FOR ANNUAL EXEMPT DISPOSAL AREA PERMIT <br /> ' FOR APPLICATION OF WASTE ASH OR SLUDGE TO LAND <br /> SITE ADDRESS: CO R R E PARCEL NO. 14 9-20 O A 3 <br /> ' NAME OF PROPERTY OWNER: N ac-O <br /> ADDRESS: S"' .33 5vu-rfl AuRO&O - SlOGKS'OP(. PHONE: Zo4. 444 -Q44 <br /> NAME OF OPERATOR: <br /> ADDRESS: PHONE: <br /> ' NAME OF HAULER: ',;�uaa t� �5� RaupN Na,/Es + soN !NIC- <br /> ADDRESS: <br /> cADDRESS:2.011? AQThuR �r� �'t.�c�4S37L PHONE: Zp9 -835-4414 <br /> ' A. Provide the following information on a scaled drawing not less than 1"=600' (Parcel <br /> Maps that meet this requirement are available at the San Joaquin County Assessor's <br /> ' Office): <br /> 1. Identify the soil amendment/stabilization area and specify the number of acres for <br /> application and the total size of the property. <br /> 2. Identify all dwellings, structures, wells, ponds, lakes, reservoirs, streams, <br /> drainage courses, or other waterways within 1000 feet of the proposed application <br /> ' site. <br /> B. Provide the following additional information: R E C E 7V1 <br /> Aid G 19 0992 <br /> 1. Duration of disposal (dates). SAN JGAQYiiN CX t J+,t;r <br /> 2. Site operation hours and days. ' Cr <br /> 3. Type of disposal site security (fences, g:itcs, natu&'b6d :A _'A,L HlALs <br /> 4. Type of waste ash or sludge to be appli -d at the proposed site. <br /> 5. Estimate total quantity of ash sludge -pplied in tons per da- per acre. <br /> 6. A work plan for applying as`,. to land. <br /> ' 7. Depth to ground water and s,:,ii y; s on site. <br /> I agree to provide the above inforn!�rrio;i and receive authorization from San Joaquin County <br /> ' Public Health Services prior to the of any waste on this property. <br /> ' Signature of Property Owner Signature of Operator <br /> ' Date: 1 3— 1 Date: <br /> 'ermit/inspection fee of $140.00 due per site, per year. <br /> -- — <br /> `�r7plication accepted with fee by Date <br />