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a ' w <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ` 1601 East Hazelton Avenue, P.O. Box 2009 <br /> r 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 , <br /> ADDRESS PHONE <br /> NAME OF OPERATOR <br /> ADDRESS N 4 PHONE b a d <br /> NAME OF HAULER S . ; <br /> ADDRESS PHONE <br /> A. Provide the following information on a scaled drawing not <br /> less than 1" = 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 /> H. 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, 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 /> S. Vector control procedures for storage of waste. <br /> I agree to provide the above information and receive <br /> authorization from the San Joaquin Local Health District prior to <br /> the dumping of any waste on this propertr'.' <br /> . <br /> Signature of Property Owner Signatu of Operator <br /> Date Date <br /> Application fee of $140.00 due per site, per year. <br /> Application accepted with fee by Date <br /> Vpd- <br />