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RHODE ISLAND DEPARTMENT OF ENVIRONMENTAL MANAGEMENT

DIVISION OF AGRICULTURE/ANIMAL HEALTH

235 PROMENADE STREET

PROVIDENCE, R.I. 02908-5767

(401) 222-2781 (TDD (401) 831-5508)

APPLICATION FOR GARBAGE FEEDING LICENSE

License #:

Date Certificate Issued: _______________

FEE: $5.00 (All Payments to be made in U.S. Currency

)

In accordance with Title 4, Chapter 3 of the General Laws, 1956 as amended entitled Garbage Feeding, the undersigned

hereby makes application to obtain a permit to feed garbage to swine, and agrees to conform to all provisions of Chapter 3,

and all regulations issued under authority thereof.

Permits must be renewed annually on the 1

Day of July.

APPLICANT’S INFORMATION

Firm Name: _________________________________________________________________________

Firm Address:________________________________________________________________________

________________________________________________________________________

Firm City:

________________________________________________________________________

Firm Telephone:______________________________________________________________________

Firm Owner’s Name:__________________________________________________________________

Firm Contact Name: __________________________________________________________________

OWNER INFORMATION:

Name of Owner: _____________________________________________________________________

Home Address: _____________________________________________________________________

_____________________________________________________________________

City/St/Zip

_____________________________________________________________________

Home Phone:

_____________________________________________________________________

MANAGER INFORMATION:

Name of Managers:______________________________________________________________

Manager’s Address:_______________________________________________________________

City: ___________________________________ State: _______________ Zip: _____________

Manager’s Home Phone: _________________________________________________________

Farm Name:____________________________________ Town where kept: ________________________________

Name of Road:__________________________________ No. of Swine: _______ No. of Feeders: _________

No. of Market Swine: ________ No. of Breeding Sows: ________ No .of Boars: _________

Cooking Equipment (Please Check) (a) Steam-Truck: ______ Open Vat: ______ Closed Vat: ______

(b) Open Fire-Vat Cooker: ______ Drums, etc.: ______

Signature: _______________________________________________Title: _________________________

Date:_____________________

SPECIAL INSTRUCTIONS (PLEASE READ CAREFULLY)

1. If changes are in order, please make changes NEATLY

Please complete form in its entirety! Sign, Date and RETURN this APPLICATION with

FEE to the above address

Any application not completed correctly will be RETURNED

If you have any questions, please call DEM/Division of Agriculture Animal Health Section at (401) 277-2781

Garbage Feeding License Application Form - Rhode Island Department Of Environmental Management

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