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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DIS 4 r n SERVING <br /> A R Glover,M.D.,Firesi" ld <br /> � �--� � city of Tracy <br /> Patricia E.Vannuccl.Secy 1601 East Hazelton Avenue, P.O. B A ''M..- — San Joaquin County <br /> Anlhonette Van Spronsen x t -' <br /> City OI Escalon <br /> Kenneth►letlel Stockton, California 95201 V1 rl;%r City of Lodi <br /> Earl Pimentel,Jr • r� ��� f City of Manteca <br /> Fern eugeee (209) 466-6781 = City of Ripon <br /> Jack' Jennings.D.D.S r,r^; ; \� LO <br /> ',A�. Crty of Stockton <br /> William J.Wade Jack J Williams,M.D.Dwric!Wealth Officer ��t.� t'�''�'���'"'`9 -t p San Joaquin County <br /> Mary Anna Love 4 h'� 'S ts '� San Joaquin County <br /> 1. Name of Applicant: 411112/r4 <br /> Address: /9101(S- So 74—11 -V A114" 'a C / <br /> Phone: oZ 3 G S—P <br /> 2. Name of 24 Hr Contact Person: ' <br /> Phone: 7 <br /> 3. Name Property Owner: h/ <br /> Address: <br /> Phone: <br /> 4. Date Initial Haul : <br /> 5. Type Waste Transported: <br /> 6. Type of Disposal Operation: <br /> Land disposal operations will require proper ground preparation. Ground preparation <br /> shall include the removal of all weeds and organic matter that might inhibit the <br /> proper spreading and drying of liquid waste material . Proper spreading and drying <br /> of all waste material is important in order to prevent an insect nuisance. All <br /> debris mixed with the waste material must be removed and disposed of in a proper <br /> manner. <br /> 7. Provide a legible drawing with the following information: <br /> (a) Identify the dipsosal site location by address and the number of acres <br /> to beutilizedin the disposal operation. <br /> (b) Identify all wells, ponds, lakes, reservoirs, streams, drainage courses <br /> or other waterways within 200' of the proposed waste disposal site area. <br /> (c) . Identify all residential dwellings within mile of the proposed disposal <br /> site are. Ohm �,11J . <br />