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STATE OF CALIFORNIA <br /> DEPARTMENT OF FOOD AND AGRICULTURE <br /> Meat,Poultry and Egg Safety Branch <br /> 1220 N Street Return completed permit requests via email to Rendering(kCDFA.ca.gov <br /> Sacramento,CA 95814 <br /> Phone:(916)900-5004 Permit# Expiration Date <br /> 79-121(Rev.08/21) 2023-LP-022 6-6-23 <br /> PERMIT REQUEST TO DISPOSE OF CARCASS(ES)OR SPECIFIED RISK MATERIAL AT A LANDFILL <br /> California Food and Agricultural Code Section 19348(b):The secretary may issue a master or individual permit to a licensed renderer,collection center,or dead <br /> animal hauler for the purpose of authorizing transport of a dead animal to an appropriately permitted landfill under either of the following circumstances: <br /> (1)During a proclaimed state of emergency or local emergency,as defined in subdivisions(b)and(c)of Section 8558 of the Government Code. <br /> (2)When the licensed hauler has certification from a licensed renderer,that the licensed renderer cannot process the dead animal due to operational conditions or <br /> legal or regulatory requirements or constraints.The certification shall be in a form approved by the department and,for purposes of this paragraph,"licensed hauler" <br /> shall include licensed collection centers and renderers. <br /> DEAD HAULER/COLLECTION CENTER/RENDERER REQUESTING APPROVAL <br /> Business Name Moniz Tallow Co CDFA License# D-163 <br /> Address P.O.Box 766 City Denair <br /> Contact Person Maurice Moniz Phone Number 209-259-9134 <br /> TO BE COMPLETED BY REQUESTOR <br /> NAME SIGNATURE DATE <br /> Maurice Moniz 5-31-2023 <br /> CARCASS COLLECTION LOCATION <br /> Address Various <br /> City County <br /> CARCASSES TO BE LANDFILLED (PER VISIT) <br /> Number of each: Cattle 20-25 Swine Shccp Goats Equinc <br /> LANDFILL INFORMATION <br /> Landfill Name Foothill Sanitary Landfill <br /> Address 6484 N.Waverly Road <br /> City Linden State Ca Zip Code 95236 <br /> Contact Person Phone Number <br /> Date of Proposed Landfill Delivery Sat 6-3-2023 and Mon 6-5-2023 <br /> REASON RENDERER WILL NOT ACCEPT/PROCESS CARCASSES(Renderer approval required) <br /> r■ INSUFFICIENT RENDERING CAPACITY ❑ EXCESSIVE DECOMPOSITION <br /> r■ EQUIPMENT MALFUNCTION/OFFLINE ❑ OTHER (Specify) <br /> Renderer Name Sacramento Rendering Co <br /> Address 11350 Keifer Blvd. City Sacramento <br /> Contact Person Mike Koewler Phone Number 916-363-4821 <br /> TO BE COMPLETED BY RENDERER <br /> NAME TITLE ISIGNATURE DATE <br /> OTHER REASON FOR LANDFILL DISPOSAL(No renderer approval required) <br /> REMOTE GEOGRAPHIC LOCATION ❑ OTHER (Specify) <br /> CDFA APPROVAL <br /> NAME TITLE DATE <br /> Brittany Cardoza SSI II 5-31-23 <br />