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St;;te of California California Integrated Waste <br /> CIWMB 502(Rev. 9/02) Management Board <br /> WASTE TIRE FACILITY <br /> ENVIRONMENTAL INFORMATION <br /> (THIS IS NOT A CEQA DOCUMENT) <br /> The following information will aid in the environmental review of your application as required by the California Environmental <br /> Quality Act(CEQA). IN ORDER FOR YOUR APPLICATION TO BE ACCEPTED AS COMPLETE,ANSWERS TO THE <br /> QUESTIONS LISTED BELOW MUST BE COMPLETED TO THE BEST OF YOUR ABILITY. Failure to answer all questions <br /> may result in your application being deemed incomplete and returned to you, causing delays in processing. If you need more space, <br /> attach additional pages. Additional information may be required from you to clarify the information requested in this form. <br /> GENERAL INFORMATION(please print or type) SWIS#: <br /> Facility Name: <br /> 77 <br /> Facility Operator's Name: <br /> Mailing Address: <br /> City; County: State: Zip: Phone: <br /> Project Address(if different from operator): <br /> County: <br /> City: State: Zip: Phone: <br /> EXISTING WASTE TIRE FACILITIES <br /> An existing waste tire facility is a facility which received, stored, or accumulated waste tires, or upon which waste tires were <br /> discarded, on January 1, 1990 (PRC 42808(a)). <br /> Is the application for an existing waste tire facility: ❑ No ❑ Yes <br /> If Yes, indicate all changes in the design and operation of the facility that occurred between January 1, 1990,and the date of <br /> submittal of this permit application: <br /> PROJECT DESCRIPTION <br /> Provide a brief description of your project, including but not limited to,site acreage,type of construction activity,structures to be <br /> built,and project operation: <br />