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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 East Hazelton Avenue, P.O. Box 2009 <br /> Stockton , California 95201 <br /> APPLICATION FOR <br /> DISPOSAL SITE EXEMPTION <br /> and <br /> FEEDING OF FOOD PROCESSING AND PACKING WASTE <br /> NAME OF PROPERTY OWNER T_)orothv ]1% <br /> ;oath. �i-� <br /> ADDRESS37621 _th. 13ird 'd. , Tracy 95376 PHONE 835°9521 <br /> NAME OF OPERATOR -0nirr ( Dnip <br /> ----------------- <br /> ADDRESS 17401) Island. Dr. 1,1adera 93638HONE673-1153 <br /> P <br /> NAME OF HAULER T)oj � -,_q r - - I <br /> ADDRESS S a-M C, as -"h n V PPHONE <br /> A. Provide the following information on a scaled drawing not <br /> less than I" = 600' (Parcel Maps that meet this requirement <br /> are available at the San Joaquin County Assessor' s Office) : <br /> 1. Identify the disposal site location , storage and/or- <br /> feeding areas and specify the number of acres. <br /> 2. Identify all dwellings, structures, wells, ponds, <br /> lakes, -reservoirs, streams, drainage courses, or other <br /> waterways within 1000' of the proposed disposal site. <br /> B. Provide the following additional information -. <br /> 1 . Duration of disposal (dates) . <br /> 2. Turnover time for feeding of waste. <br /> 3. Type of disposal site security (fences, <br /> . gates, natural <br /> boundries) . <br /> 4. Type of waste to be fed or dumped at the proposed site. <br /> 5. Estimate total quantity in yards or tons per day and <br /> per acre. <br /> 6. Provide work plan for applying waste to land . <br /> 7. Describe all contingency plans for selecting <br /> alternative sites and provide the location of all <br /> alternative sites should weather conditions warrant <br /> this condition. <br /> 8. Vector control procedures for storage of waste. <br /> I agree to pro'vide the above information and receive <br /> authorization from the ..San Joaquin Local Health District prior to <br /> the dump4ng of any waste on this proper <br /> ' Signature Property Owner Signature of (]Pe tor <br /> Date <br /> AppftE­�t1bh fft Ot $140.00 due per site, per year. <br /> A"0404*40A accepted 6*$tf -te bar Date <br />