Laserfiche WebLink
lication 'Vo. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P O Box 2009 PAYMEIYT <br /> Stockton, CA 95201 EI <br /> APPLICATION FOR JUN 13 <br /> DISPOSAL SITE EXEMPTION <br /> and .ENVIRONMENTAL <br /> FEEDING OF FOOD PROCESSING AND PACKING WASTE PERMIT/SERVICESALTH <br /> NAME OF PROPERTY OWNER ct <br /> ADDRESS L c s d PHONE <br /> NAME OF OPERATOR <br /> ADDRESS _1 PHONE � I . <br /> NAME OF HAULER I' <br /> ADDRESS t`6 ► PHONE <br /> A. Provide the following information on a scaled drawing not less than 1 <br /> 600' (Parcel Maps that meet this requirement a1,e available at the San <br /> Joaquin County assessor' s Office) : <br /> 1 . Identify the disposal site location, storage and/or feeding areas and <br /> specify the number of acres. <br /> 2. Identify all dwellings, structures , wells, ponds, lakes, reservoirs, <br /> streams, drainage courses, or other waterways within 1000 ' of the prop- <br /> osed 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, gates, natural 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 per acre. ` <br /> 6. Provide work plan for applying waste to land. <br /> 7. Describe all contingency plans for selecting alternative sites and <br /> provide the location of all. alternative sites should weather conditions <br /> warrant this condition. <br /> 8. Vector control procedures for storage of waste. <br /> I agree to provide the above information and receive authorization from the <br /> San Joaquin Local Health District prior to the dumping of any waste on rhi.s <br /> property. <br /> Signa ure of Property Owner Si nature of Operator <br /> Date Date <br /> Application fee of $140.00 due per site, per ye r. <br /> Application accepted with fee by Date ' <br />