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'��!AM <br /> SAN 1PAQUIN LOCAL HEALTH D STRICT <br /> 1601 East Hazelton Avenue, P.O. Box 2009 <br /> Stockton , California 95201 <br /> f3�U I"� <br /> 9, <br /> APPLICATION FOR <br /> DISPOSAL S I..�.r:: <br /> EXEMPTION �tAvi �r . r`4ViC� <br /> and ,n,i�{ <br /> FEEDING OF FOOD PROCESSING AND PACKING WASTE <br /> I <br /> NAME OF PROPERTY OWNER; 1^ .S <br /> ADDRESS PHONE <br /> NAME OF OPERATOR 6 hf j <br /> ADDRESS PHONE <br /> NAME OF HAULER 1£ <br /> ADDRESS oo PHONE 5-37- V�lG, <br /> A. Provide the following information on a scaled drawing not <br /> less than I" = 600' (Parcel Maps that meet this requirement <br /> E are available at the SanJoaquin 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 /> 4. Turnover time for- feeding of waste. <br /> 3. Type of disposal site security (fences, gates, natural <br /> boundries) . <br /> 4. Type of waste to he 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 /> a. 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 UU11 ng of any waste on this property. <br /> Signature of Property Signatur of Operator <br /> Date a V I I -- Date <br /> Application fee of $140.00 due per site, per year. <br /> Application accepted with fee by <br />