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I6 <br /> %Dlication No. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P O Box 2009 <br /> Stockton, CA 95201 <br /> APPLICATION FOR <br /> DISPOSAL SITE EXEMPTION <br /> and <br /> FEEDING OF FOOD PROCESSING AND PACKING WASTE <br /> NAME OF PROPERTY OWNER 1��XflJ k IS�Ek. <br /> ADDRESS SSS lam/ , oy IS' )_1 PHONE Z&/ <br /> NAME OF OPERATOR /t//.Z,/ <br /> ADDRESS 7 0 PHONE <br /> NAME OF HAULER V/,1L/1fM �a 7.L C71_ML-1C/e <br /> ADDRESS PHONE ��- <br /> A. Provide the following information on a scaled drawing not less than 1"= <br /> 600 ' (Parcel Maps that meet this requirement are available at the San <br /> Joaquin County assessor' s Office) : <br /> 1 . Identify the disposal site location, storage and/or feeding areas and <br /> specify the number of acres. 7S(30- <br /> 2 . Identify all dwellings, structures , wells, ponds, lakes, reservoirs , <br /> streams , drainage courses, or other waterways within 1000 ' of the prop- <br /> osed 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 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 per acre. <br /> 6. Provide work plan for applying waste to land. <br /> 7. Describe all contingency plans for selecting alternative sites and <br /> provide the location of all alternative sites should weather conditions <br /> warrant this condition. <br /> 8. Vector control procedures for storage of waste. <br /> I agree to provide the above information and receive authorization from the <br /> San Joaquin Local Health District prior to the dumping of any waste on this <br /> p rjSo�q erty. <br /> Signature of Property Owner Signature of OQp'ep or <br /> Date P - C"?, 5 Y 6yDate <br /> Application fee of $140.00 due per site, per <br /> year. <br /> Application accepted with fee by �,��,.,�r�„ .. ..,,,.n. Date T S AB <br /> c� <br />