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BOARD OF TRUSTEES sN JOAQUIN LOCAL HEALTH DIST SERVING <br /> A.R.Glover,M.D.,Pres. City of Tracy <br /> Patricia E.Vannucci,Secy. 1601 East Hazelton Avenue, P.O. Box 2009 San Joaquin County <br /> Anthonette Van Spronsen City of Escalon <br /> James Culbertson Stockton, California 95201 City of Lodi <br /> Earl Pimentel City of Manteca <br /> Fern Bugbee City of Ripon <br /> Daniel L.Flores (209)466-6781 City of Stockton <br /> William J.Wade San Joaquin County <br /> Mary Anna Love Jogi Khanna,M.D.,M.P.H.,District Health Officer San Joaquin County <br /> 1. Name of Applicant: &/tri 2 C. t a <br /> Address: l( 3 5 tr W l�1 r� 3 F2 2 v � <br /> Phone: 2 b ly k 6 3 et 2( ) (�, <br /> 2. Name of 24 Hr Contact Person: ''j-1 /vl I ci IV y 'ZC <br /> Phone: a o q 44 ? 8 - 3c? 7 <br /> 3. Name Property Owner: S v ,N j7 R y "PI-e-6 0 C)�:- T- <br /> Address: r21y A �. i A i � Pcs � I' - 3 Yt3 i G,:ir-FE it,,��a <br /> Phone: Zoq - 835 y52 <br /> 4. Date Initial Haul : S v >, <br /> 5. Type Waste Transported: I-C) 'M r <br /> 6. Type of Disposal Operation: o �_ a 1Z V Q y I n/& <br /> Land disposal operations will require proper ground preparation. Ground preparation <br /> shall include the removal of all weeds and organic matter that might inhibit the <br /> proper spreading and drying of liquid waste material . Proper spreading and drying <br /> of all waste material is important in order to prevent an insect nuisance. All <br /> debris mixed with the waste material must be removed and disposed of in a proper <br /> manner. <br /> 7. Provide a legible drawing with the following information: <br /> (a) Identify the dipsosal site location by address and the number of acres <br /> to be utilized in the disposal operation. <br /> (b) Identify all wells, ponds, lakes, reservoirs, streams, drainage courses <br /> or other waterways within 200' of the proposed waste disposal site area. <br /> (c) Identify all residential dwellings within 1 mile of the proposed disposal <br /> site are. <br /> �j <br /> Q � a 0 <br /> SEP 2 E 1985 <br /> ENVIROMENTAL HEALTH <br /> F ERMIT/SERVICES <br />