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r , r <br /> `i <br /> BOARD Of TRUSTEES S -'JOAQUIN LOCAL HEALTH DISTOT SERVING <br /> A.R.Glover,M.D.,Pres. City or 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 CulbertsonStockton, California 95201 ciry"'Lodi <br /> Earl Pimentel City of Manteca <br /> Fern Bugbee (QQ9)466-6781 City of Ripon <br /> Daniel L.Flores City of Stockton <br /> William J.Wade San Joaquin County <br /> Mary Anna Love Jogi Khanna,M.O.,M.P.H.,District Health Officer Sari Joaquin County <br /> y. <br /> li <br /> 1. Name of Appl icant: C 3 r`A -�n rF-fZ C 11�_L5rA, <br /> Address: 2 Ay tz - 5'TGL � 'T'd �► <br /> Phone: a (D9 ci9 (1 <br /> 2. Name of 24 Hr Contact Person: T AA <br /> Phone: - a'l 7 K - 3 D <br /> 3. Name Property Owner: <br /> Address: i,AcYNjNr~� + -'AAk'Nirri-C/.4. _V <br /> Phone: 'L 0 9 <br /> - s <br /> 4. Date Initial Haul : e� <br /> 5. Type Haste Transported: 'T_-c) 1 .A-A •`t- d <br /> 6. Type of Disposal Operation:' 6 -1— <br /> Land <br /> iLand disposal operations will require proper ground preparation. Ground preparation <br /> shall include the removal of all weedsand organic matter that might inhibit the <br /> f; <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 /> 1. 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 L mile of the proposed disposal <br /> site are. <br /> X <br /> ;a <br /> t 1. <br /> ,gd•. .�.. - - d4 Yt;i:t+'''r 1.d+�k s- r#r,tP'�a7, '�,»�'al zz - _ .. - _ - <br />