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Application SSS-la <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P 0 Box 2009 YCAEIIT <br /> REStockton, CA 95201 GEIVE� <br /> APPLICATION FOR <br /> DISPOSAL SIITEE EXEMPTION TASMEAI.IVA <br /> an <br /> FEEDING OF FOOD PROCESSING AND PACKING WASTE FNN11W0 u41P ACES <br /> NAME OF PROPERTY OWNER <br /> ADDRESS PHONE.,:24o' <br /> NAME OF OPERATOR <br /> ADDRESS PHONE Q <br /> NAME OF HAULER <br /> ADDRESS PHONE - PJ <br /> A. Provide the following information on a scaled drawing not less than 111= <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. <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 /> prop ty. <br /> Z" <br /> ignature o Prop y Owner Signature of erator <br /> Date 2— p2 0IL.LDate <br /> Application fee of $140.00 due per site, per year. <br /> Application accepted with fee by Date <br />