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� <br /> SAN JOAQU%N LOCAL HEALTH DISTRICT <br /> 1601 East Hazelton Avenue, P.O. Box 2009 <br /> Stockton, California 95201 <br /> APPLICATION FOR <br /> DISPOSAL SITE EXEMPTION <br /> and <br /> FEEDING OF FOOD PROCESSING AND PACKING WASTE <br /> ADDRESS <br /> NAME OF OPERATOR <br /> ADDRESS I REq/_L WR9 <br /> ADDRESS -.0 k X &92 M§ftUW2_ ^% <br /> PERMIUSEWUS <br /> A. Provide the following information on a scaled drawing not <br /> less than 1" := 600' (Parcel Maps that meet this requirement <br /> are available at the San Joaquin County Assessor' s Office) : , <br /> 1~ Identify the disposal site location, storage and/or <br /> feeding areas and specify the number of acres. <br /> 2. Identify all dwellings, structures, wells, ponds, <br /> lakes, reservoirs, streams, drainage courses, or other ' <br /> waterways within 1000^ of the proposed disposal site. <br /> B. Provide the following additional information : <br /> . 1. Duration of disposal (dates) . <br /> 2. Turnover time for feeding of waste. <br /> 3. Type of disposal site security (fences, gates, natural <br /> boundries) . <br /> 4. Type of waste to be fed or dumped at the proposed site. <br /> 5. Estimate total quantity in yards or tons per day and <br /> per acre. <br /> 6. Provide work plan for applying waste to land. <br /> 7~ Describe all contingency plans for selecting <br /> alternative sites and provide the location of all <br /> alternative sites should weather conditions warrant <br /> this condition. <br /> 8. Vector control procedures for storage of waste. <br /> 1 agree to provide the above information and receive ' <br /> authorization from the San Joaquin Local Health District prior to . <br /> the dumping of any waste on this property. <br /> Signatfftre of Property Owner Sirgnatu1r%_'RFZEp_erator <br /> Date ZLY�Z Date <br /> Application fee of $140~00 due per site, per Year. <br /> Application accepted with fee by Date <br /> � <br /> � <br /> �/.pn <br />