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PUBLIC 11EALTH SERVICES pO,U!,N <br /> SAN JOAQUIN COUNTY <br /> r.� <br /> ENVIRONMENTAL HEALTH DIVISION Z< <br /> Ernest M. Fujimoto, M. D., M.P.H., Acting Health Officer •` <br /> 304 E. Weber Ave., Third Floor • P. O. Box 388 • Stockton, CA 95201-0388 <br /> 209/468-3420 <br /> APPLICATION FOR DISPOSAL SITE EXEMPTION <br /> & FEEDING OF FOOD PROCESSING <br /> & PACKING WASTE <br /> Name of Property Owner: T') !r 1 <br /> Address: ! ' �( '� 1 V F Q �1 n�C (, `•� <br /> Name of Operator: <br /> T <br /> Address:' <br /> Name of Hauler: ( .-r— <br /> Address: <br /> Provide the following information on a scaled drawing not less than one inch equals six hundred feet (1"= 600'). <br /> Parcel Maps that meet this requirement are available at the San Joaquin County Assessor's Office: <br /> • Identify the disposal site location, storage and/or feeding areas and specify the number of area. <br /> • Ident* all dwellings, structures, wells, ponds, lakes, reservoirs, streams, drainage courses, or other <br /> wateMays with one thousand feet (1,000') of the proposed disposal site. <br /> Provide the following additional information: <br /> • Duration of disposal (dates). ti » <br /> • Turnover time of feeding of waste. � A- "r "� <br /> • Type of disposal site security (fences/gates/natural boundaries). . <br /> • Estimate total quantity in yards or tons per da and per acre. <br /> q tY Y P Y P orr" <br /> • Provide a work plan for applying waste to the land. <br /> • Describe all contingency plans for selecting alternative sites and provide the location of all alternative sites <br /> should weather conditions warrant this condition. <br /> • Vector control procedures for storage of waste. <br /> I agree to provide the above information and receive authorization from the San Joaquin County Public Health <br /> Department, Environmental Health Division prior to the dumping of any waste on this property. <br /> Signature of Proper�.-A nor U D <br /> Signature of Operator e <br /> Application accepted with fee by <br /> —A 7,,�,,;• Date <br /> 31 ti A Division of San Joaquin County Health Care Services <br />