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SAN QUIN COUNTY PUBLIC HFALTI•I VICES <br /> FN vTRONNIENI'AL HEALTH DIVISI N <br /> 445 N. SAN JOAQUIN STREB7, P.O. SOX 2009 <br /> STOCKTON, CA 95201 <br /> (209) 468-3420 <br /> APPLICATION FOR ANNUAL EXEMPT DISPOSAL AREA P <br /> Fo>Z APPLICATION OF WASTE ASH OR SLUDGE TO LAND <br /> SrM ADDRESS: U n i o n Island PARCEL NO- --010-11 <br /> NAME OF PROPERTY OWNER: <br /> Al7DRESS: MONS: 209 qac 2074 <br /> NAmm OF OPERATOR: Bu d-dj H a e s <br /> ADD 5:2.0177 S MacArthur Dr/Trac CA pHONE: 209 835 4914 <br /> NAME OF HAULER: _ Ralp°h Hayes & Son , Inc . <br /> ApDRESS:20177 S MacArthur Dr/Trac CA 95376 PHON 'E:209 835-491.4 <br /> + A. Provide the following information on a scaled drawing not less than 1"=500' (Parcel <br /> Maps that meet this requirement are available at the San Joaquin County Assessor's <br /> Office): <br /> 1. Identify the soil imendmendstabilization arm and specify the number of acres for <br /> application and the total size of the prOperty. <br /> 2. Identify all dweUn s, junctures, wells, poneds, lalm. re3ervoin, strems. <br /> drainage courses, or other waterways within 1000 fed of the proposed application <br /> site. k Y k" <br /> . Provide the following additional information: AUG I S100,2 <br /> A� " <br /> I. Duration of disposal (dates). UBL±C <br /> 2. Site operation hours and days. FNVIRON[,,?!ENoA1'6E � <br /> 3. Type of disposal site security (fences, gates, natural boundanes). <br /> 4. Type of waste ash or sludge to be applied at the proposed site. <br /> 5, Estimate total quantity of ash or sludge applied in tons per day and per acre. <br /> 6. A work plan for applying ash or sludge to land. <br /> 7. Depth to ground water and soil types on site. <br /> I agmee to provide the above information and receive authorization from San Joaquin County <br /> Public Services to the spreading of any w to on this praperty. <br /> 2 <br /> ignature o roperty Owner Signature of Operator <br /> Dater Date: <br /> Perm it/inspection fee of S140.00 due per site, per yeaf. <br /> Application =--pted with fee- by Date <br />