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SERVtv'sPUBLIC LALTH <br /> SAN JOAQUIN COUNTY ?a <br /> ENVIRONMENTAL HEALTH DIVISION N <br /> Karen Furst, M.D., M.P.H., Health Officer <br /> G/ <br /> 304 East Weber Avenue, Third Floor • Stockton, CA 95202 ppR <br /> 209/468-3420 <br /> APPLICATION FOR DISPOSAL SITE EXEMPTION <br /> FEEDING OF FOOD PROCESSING <br /> PACKING WASTE <br /> Name of Property Owner: <br /> Address: <br /> Name of Operator: <br /> Address: <br /> Name of Operator: <br /> Address: <br /> Provide the following information on a scaled drawing not less than one inch equals six hundred feet <br /> (1"=600'). Parcel maps that meet this requirement are available at the San Joaqquin County Assessor's <br /> Office. <br /> • Identify the disposal site location, storage and/or feeding areas and specify the number of areas. <br /> Identify all dwellings, structures, wells, ponds, lakes, reservoirs, streams, drainage courses, or other <br /> waterways within one thousand (1000') feet of the proposed disposal site. <br /> Provide the following additional information: <br /> • Duration of disposal (dates) <br /> • Turnover time of feeding of waste <br /> • Type of disposal site security (fences/gates/natural boundaries). <br /> • Estimate total quantity in yards or tons per day per acre. <br /> • Provide work plan for applying waste to land. <br /> • Describe contingency plans for selecting alternative sites and provide the location of all possible <br /> alternative sites that could be used in case of inclimate weather. <br /> • Describe vector control procedures for storage of waste. <br /> I agree to provide the above information and receive authorization from San Joaquin County Public <br /> Health Services, Environmental Health Division prior to placing any waste on this property. <br /> Signature of Property Owner Date <br /> Signature of Operator Date <br /> Application accepted with fee by <br /> Date <br /> A Division of San Joaquin County Health Care Services <br />