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-..+� aw.c+^�-AG[.-.. L.�-...rR{V 3ZZLasY".(i-1:_C7• ZFG7�'aC r7'00'1 <br /> '•a <br /> (209) 468-3420 <br /> APPLICATION FOR ANNUAL ExEmPT DISPOSAL AREA PHRM�T <br /> FOR APPLICA'T'ION OF CANNERY WASTE TO LAND AND FOR AL <br /> ENVIRONMENTAL HEALTH PERMIT FOR. ANIMAL FEED Y,� <br /> SITE ADI]RESS: A PARCEL. NO. <br /> NAME OF PROPERTY OWNER: c L a"'v <br /> ADDRESS: �10 (,•61. 66ff ZI9�537& PHONE: 135 <br /> NAME OF OPERATOR: r A��L e k <br /> ADDRESS: � i9 lei �P11. r.�C'y �53M6 PHONE: - 6 d?�7 <br /> NAME OF HAULER: �.� ` /l <br /> ADDRESS:M ,Z: /X �`_ PHONE. V DI <br /> A. Provide the following information on a scaled drawing not less than 1"— ' (Parcel <br /> Maps that .meet this requirement are available at the San Joaquin Coun Assessor's <br /> Office): <br /> 1. Identify the soil amendment/stabilmation or feed yard area and speciP.r the number <br /> of acres for application and the total size of the property. <br /> 2. Identify all dwellings, structures, wells, ponds, falces, reservoi , streams, <br /> drainage courses, or other waterways withij. 1000 feet of the proposeo application <br /> site or feed yard. <br /> B. Provide the followiuEg additional information: <br /> 1. Duration of disposal (dates). ' <br /> 2. Site operation hours and days. <br /> 3. Type of disposal site security (fences, gates, natural boundaries). <br /> 4. Type of waste to be applied or fed at the proposed site. <br /> 5. Estimate total quantity of waste applied in tons per day and per acr.-.. <br /> 6. A work plan for applying waste to land. <br /> 7. Depth to ground water and soil types on site. <br /> 8. Turnover time for feeding of waste. <br /> 9. Vector control procedures. <br /> 10. Drainage system at cannery waste storage area.. <br /> I agree to provide the above information and I must receive authorization from San Joaquin <br /> County Public Health Services prior to operation of this site. <br /> { I 'JI <br /> IIAII/�11A.71AA 5 1 <br /> -- <br /> Sigfiat= of Property/Owner Signature of Operator <br /> Date: y `� Date: 7. 4� <br /> Fn ❑1 - WO?la WW.P:OZ VaGI-FI-1.0 <br />