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'STATE OF CALIFORNIA <br /> REGIONAL.WATER QUALITY CONTROL BOARD <br /> DEPARTMENT OF HEALTH SERVICES <br /> SOLID WASTE MANAGEMENT BOARD <br /> DEPARTMENT OF rORESTRY <br /> APPLICATION FOR <br /> FACILITY PERMIT/WASTE DISCHARGE <br /> This form is to be used for filing alan: (check all appropriate) FOR OFFICE USE ONLY <br /> 1. ®X REPORT OF WASTE DISCHARGE Form 200 Recd __ -- <br /> (pursuant to Division 7 of the State Water Code) Fee(RWQCBI ISWM81___ <br /> 2. APPLICATION FORA HAZARDOUS WASTE FACILITY P RMIT Letter to Discharger <br /> (pursuant to Health and Sa'aty Code Section 252001 Report Recd <br /> 3. APPLICATION FOR A SOLID WASTE FACILITIES PERmrr Effective Date <br /> (pursuant to Government Code Section 66796.301 <br /> CDF Notified <br /> 4- APPLICATION FOR A RUBBISH DUMP PERMIT — <br /> (pursuant to Public Resources Code Sections 4371-4375 and 44,M) DOHS No. <br /> SWMB <br /> -- 1. FACILITY <br /> r[LsnNON[ � <br /> A. NAMS OF FACILITY <br /> FAST GAS ( 209 } 333-9718 <br /> _ ---- -- r-•COD■ <br /> waaw[sY <br /> 800 'EAST HIGHWAY 12, LODI , CA 95240 <br /> a. NAME OF LGGALGw NKR OF FAC1L+Tr r[u•N ON[� <br /> DOUGLAS/KAYO OIL COMPANY �__ 1615 ? 756-5770 <br /> zv coos <br /> �Do wsas <br /> 1221 EAST MAIN STREET, CHATTANOOGA TN 37408 <br /> C. NAMN OF at181NESS OPrtw ATIN6 FACILITY r[Ls•N 4Ne • <br /> SAME AS ABOVE 1209 1 368-2731 <br /> _. !u coos <br /> woawsa[ <br /> 900 S. CHEROKEE LAriE�P.O. BOX 190, LODI, CCA 95241 <br /> o:TY►R or BUSINEse oFaRwTING FACILITY <br /> Sole Proprietorship Partnership X Corporation Government Agency <br /> U. NAME Or OWNUIET-S7 OF ■L1a1NRas OPi RATING FACILITY rsu•Rows . <br /> ( 615 1 756-5770 <br /> ZIA Gob{ i <br /> ADORES•wNER[LEGAL NaT,C■ MAY w■■[■V[O <br /> 1221 EAST MAIN STREET, CHATTANOOGA, TN 37408 <br /> 11. REASON FOR FILING <br /> eNsc.ALL w.►RD•Rurst <br /> i <br /> A. X 1 New discharge or facility D. Change in chof atter of discharge G. Changein'business operating facility <br /> B. Existing discharge or facility E. Change in pl or method of disposal H. Enlargement of existing facility <br /> C. Increase in quantity of discharge F. Change in desi n or operation -1. Other(explain below) <br /> -- -- - -- - -- 111. TYPEF OPERATION <br /> _ Oj <br /> CN[CR ALL A••ROMRtAT[t - <br /> A, Transfer station Q. Sewage treatment G. 8 Woodwasts site <br /> B. Solid waste disposal site <br /> E. X Industry Ion-s to disposal facility) H. Other(explain below) <br /> C. Hazardous waste disposal site F. Industry Idist arge to sewer) <br /> IV. TYPE Oil wAaTE J <br /> C.9C.ALL A••Ro0wl.Ts1 - <br /> A Sewage,sewage sludge,and/or E. Agricultural astas 1. Inert materials <br /> septic tank pumpings l <br /> B. Dead animals <br /> Industrial wastes F. Animal was J. <br /> C. Municipal solid wastes G. Forest product wastes K. Tire`s <br /> D. Hazardous wastes H. Construction/ molition wastes L Other(explain below) <br /> -- <br /> V. SITE DESIGN CAPACITY <br /> A,•w[o[wT PD•VLATIOw aw CAPACIT• •.Ow•,Ow•O•YLATIDR aR Y TA"A"CAPAGITV G LI/[i.�K CTANO• •SSSS <br /> roRM see (REv.sHY) (O VB ) <br />