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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DMSION <br /> 445 N. SAN JOAQUIN STREET, P.O. BOX 2009 <br /> STOCKTON, CA 95201 <br /> (209) 468-3420 <br /> APPLICATION FOR ANNUAL EXEMPT DISPOSAL AREA PERMIT <br /> FOR APPLICATION OF WASTE ASH OR SLUDGE TO LAND <br /> SITE ADDRESS: Mac Donald Island PARCEL NO .129-080=53 Pg.8. <br /> NAME OF PROPERTY OWNER: EDWARD ZUCKERMAN <br /> ADDRESS: /// A) - Zuckerman Road e�_ PHONE: <br /> NAME OF OPERATOR: <br /> ADDRESS: 20177 S. MacArthur Drive Tracy (95376) PHONF-209-835-4914 <br /> NAME OF HAULER: Buddy Hayes <br /> ADDRESS: 20177 S. MacArthur Drive Tracy (95376) PHON-E: 209-835-4914 <br /> + A. provide the following information on a scaled drawing not less than 1"=600' (Parcel <br /> Maps that meet this requirement are available at the San Joaquin County Assessor's <br /> Office): <br /> 1. Identify the soil amendment/stabilization area and specify the number of acres for <br /> application and the total size of the property. <br /> 2. Identify all dwellings, structures, wells, ponds, lakes. reservoirs, streams, <br /> drainage courses, or other waterways within 1000 feet of the proposed application <br /> site. <br /> PAYMENT <br /> B. Provide the following additional information: RECEIVED <br /> AU 0 19 1992 <br /> I. Duration of disposal (dates). SAN J c;AQ U s N ;'Ci!,)N T Y <br /> 2. Site operation hours and days. PlU'Elie HEALTN Rv;l <br /> 3. Type of disposal site security (fences, gates, natural b h jf I-� '�'' ''�V'"' �' <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 agree to provide the above information and receive authorization from San Joaquin County <br /> Public Health Services prior to the spreading of any,-waste on this property. <br /> Pnatu of Property Owner Sign of Operator <br /> Date: 1 Date: 13) <br /> Permit/inspection fee of S140.00 due per site, per year. <br /> Application 3cc.-pted with fee by e <br />