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LiTATE OF CALIFORNIA <br /> REGIONAL WATER QUALITY CONTROL BOARD <br /> DEPARTMENT OF HEALTH SERVICES <br /> SOLID WASTE MANAGEMENT BOARD <br /> ! DEPARTMENT OF FORESTRY <br /> } APPLICATION FOR <br /> FACILITY PERMIT/WASTE DISCHARGE <br /> This form is to be used for filing a/an: (check all appropriate) FOR OFFICE USE ONLY <br /> 1. U REPORT OF WASTE DISCHARGE Form 200 Recd --- <br /> (pursuant to Division 7 of the State Water Code) Fee(RWOCB) (SWMB)__ <br /> 2. APPLICATION FOR A HAZARDOUS WASTE FACILITY PERMIT Letter to Discharger <br /> (pursuant to Health and Safety Code Section 25200) Report Recd <br /> 3. APPLICATION FOR A SOLID WASTE FACILITIES PERMIT Effective Date <br /> (pursuant to Government Code Section 66796.30) <br /> 4. F] APPLICATION FOR A RUBBISH DUMP PERMIT CDF Notified <br /> (pursuant to Public Resources Code Sections 4371--4375 and 4438) DOHS No._ <br /> SWMB No. <br /> 1. FACILITY <br /> A. NAM[ OF FACILITY TELEPHONE • <br /> Valley Forklift ( 209 ) 931-1531 <br /> ADORES{ IIP Coca <br /> 3200 Eight Mile Road, Stockton, CA 95212 <br /> IS. NAM[ OF LEGAL OWNER OF FACILITY Ta LI♦HONE • <br /> Tri Valley Growers ( 415 ) 445-1600 <br /> ADORE{{ <br /> IIP CODE <br /> 1255 Battery Street, San Francisco, CA 94120-7114 <br /> C. NAM[ OF BUSINESS OPERATING FACILITY Ta L[►H ONa • <br /> Valley Forklift ( 209 ) 572-5440 <br /> .00R.$$ IIP COOK <br /> 760 S. Riverside Drive, Modesto, CA 95354 <br /> D. TYPE OF BUSINESS OPERATING FACILITY <br /> Sole Proprietorship Partnership Corporation Government Agency <br /> E. NAME OF OWNIERTSI OF BUSINESS OPERATING FACILITY TELEPHONE • <br /> Tri Valley Growers ( 415 ) 445-1600 <br /> ADDRESS WHERE LEGAL NOTICE MAY E■ f[RVaD IIP CODE <br /> 1255 Battery Street, San Francisco, CA 94120-7114 <br /> It. REASON FOR FILING <br /> CHECK ALL APPROPRIAY[: <br /> A. X New discharge or facility D. Change in character of discharge G. Change in business operating facility <br /> B. Existing discharge or facility E. Change in place or method of disposal H. Enlargement of existing facility <br /> C. Increase in quantity of discharge F. Change in design or operation I. Other(explain below) <br /> -- - -- - 111. TYPE OF OPERATION <br /> CHECK ALL APPROPRIATE: <br /> A. Transfer station D. Sewage treatment G. 8 Woodwaste site <br /> B. Solid Waste disposal site E. Industry (on-site disposal facility) H. X Other(explain below) <br /> C. Hazardous waste disposal site F. Industry (discharge to sewer) Forklift steam cleaning system <br /> IV. TYPE OF WASTE <br /> CHECK ALL APPROPRIATE: <br /> A Sewage,sewage sludge,and/or E. Agricultural wastes I. Inert materials <br /> septic tank pumpings <br /> B. Industrial wastes F. Animal wastes J. Dead animals <br /> C. Municipal solid wastes G. Forest product wastes K. Tires <br /> D. Hazardous wastes H. Construction/demolition wastes L. X Other(explain below) No discharc: <br /> Effluent is reclaimed for forklift cleaning <br /> V. SITE DESIGN CAPACITY <br /> A. PRESENT POPULATION OR CAPACITY E.DESIGN POPULATION OR ULTIMATE CAPACITY C. LIP[ [RPECTANCY YEAR{ <br /> N/A <br /> FORM 200 (REV. 5/60) (OVER) <br />