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SAN JOAN COUNTY PUBLIC HEALTH SSCES <br /> ENVIRONMENTAL HEALTH DIVISION <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 CANNERY WASTE TO LAND AND FOR ANNUAL <br /> ENVIRONMENTAL HEALTH PERMIT FOR ANIMAL FEED YARDS <br /> SITE ADDRESS: `� N' �� '� " '" '�d C"" PARCEL NO. <br /> NAME OF PROPERTY OWNER: ', �' /Ya e <br /> ADDRESS: I / q lV OP fnr� lei C�- PHONE: <br /> NAME OF OPERATOR: <br /> ADDRESS: PHONE: <br /> NAME OF HAULER: V P L <br /> ADDRESS: 11/ HW!Z d PHONE: <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 or feed yard area and specify the number <br /> of acres for 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 or feed yard. <br /> B. Provide the following additional information: <br /> 1. Duration of disposal (dates). <br /> 2. Site operation hours and days. <br /> 3. Type of disposal site security (fences, gates, natural boundaries). <br /> 4. Type of waste to be applied or fed at the proposed site. <br /> 5. Estimate total quantity of waste applied in tons per day and per acre. <br /> 6. A work plan for applying waste to land. <br /> 7. Depth to ground water and soil types on site. <br /> 8. Turnover time for feeding of waste. <br /> 9. Vector control procedures. <br /> 10. Drainage system at cannery waste storage area. <br /> I agree to provide the above information and I must receive authorization from San Joaquin <br /> County Public Health Services prior to operation of this si <br /> Signature of Property Qwner _ Signa of Operator <br /> Date: /`> / 3 Date: �� <br />