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STATE OF CALIFORNIA <br />CALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD <br />REGIONAL WATER OUALITY CONTROL BOARD <br />APPLICATION FOR SOLID WASTE FACILITY PERMIT/WASTE DISCHARGE REQUIREMENTS <br />CIWM6 E•1-77 (Rev. 904) <br />NOTE: This form has been developed for multiple uses. It is the transmittal sheet for documents required to be submitted to the appropriate agency. <br />Please refer to the attached instructions for definitions of terms and for comoletina this aoofcation form in a comnlata and cnrrer_t man Ar <br />FOR OFFICIAL USE ONLY <br />SWIS NUMBER: <br />(` . <br />FILING FEE: <br />RECEIPT LIMBER: <br />DATE RECEIVED: <br />e <br />ATE ACCEPTED: <br />/ <br />117B <br />DATE REJECTED- <br />ACCEPTANCE DATE OF <br />INCOMPLETE <br />67 <br />APPLICATION:- <br />PPLICATION:DATE DUE: <br />DATE <br />MN <br />Part 1. GENERAL INFORMATION <br />A. ENFORCEMENT AGENCY: B. COUNTY: <br />San Joaquin County, Environmental Health Department San Joaquin <br />M 1, NEW SWFP arr/or WDRS <br />5. REVISION OF SWFP andlor WDRS <br />114. PERMIT REVIEW <br />115. AMENDMENT OF APPLICATION <br />113. EXEMPTION and/or WAIVER 6. RFVROWD/JTD AMENDMENTS <br />NON <br />Part 2. FACILITY DESCRIPTION <br />A. NAME OF FACILITY: <br />Forward Landfill <br />B. LOCATION OF FACILITY: <br />1. PHYSICAL ADDRESS OR LOCATION AND ZIP CODE: <br />9999 South Austin Road, Manteca, CA 95336 <br />2. LATITUDE AND LONGITUDE: <br />Latitude 37` 52'39.38", Longitude 121" 11'23.90" <br />3. LEGAL DESCRIPTION OF PERMITTED BOUNDARY BY SECTION, TOWNSHIP, RANGE, BASE, AND MERIDIAN, IF SURVEYED: <br />Section 3 of Township 1 S, Range 7E, Mount Diablo Baseline and Meridian (MDB&M), Section 34 of Township 1 N, Range 7E MDB&M, and Section 10 of <br />Township IS, Range 7E MDB&M. Assessor Parcel Nos. 181-150-07,181-150-08,181-150-09,181-150-10,201-060-01, 201 -060-02,201-060-03,201- <br />060-04, <br />01-060-02,201-060-03,201- <br />060-04, 201-060-05. and 201-070-01. <br />C. TYPE OF ACTIVITY: (Check applicable boxes): <br />®1. DISPOSAL Q3, TRANSFORMATION ®5. OTHER (describe): ACW Disposal Site <br />a. TYPE: Class 11 and Class III (see JTD pages 4-1 through 4-3) <br />M2, COMPOSTING M4. TRANSFERIPROCESSING FACILITY <br />a. TYPE: ❑ CHECK HERE IF RECYCLABLE MATERIALS ARE RECOVERED PRIOR TO TRANSFER/PROCESSING. <br />D. CONFORMANCE FINDING INFORMATION (CIWMP): <br />®1, FACILITY IS IDENTIFIED IN (Check one): <br />LX SITING ELEMENT DATE OF DOCUMENT April 1996 PAGE M 18-23 <br />❑NONDISPOSAL FACILITY EL DATE OF DOCUMENT PAGE N <br />n2. FACILITY IS NOT REQUIRED TO BE IDENTIFIED IN SITING ELEMENT OR NONDISPOSAL FACILITY ELEMENT <br />E. TYPE OF PERMITTED WASTES TO BE RECEIVED: (Check applicable boxes): <br />®1. AGRICULTURAL ®6. CONSTRUCTIOWDEMOUTION M11. LIQUIDS <br />®2. ASBESTOS 0 Friable O Non -friable ®7. CONTAMINATED SOILS 012. MIXEDrMUNICIPAL SOLID WASTE <br />®3. ASH ®it. DEAD ANIMALS (small) ®13. SEWAGE SLUDGE <br />®4. AUTO SHREDDER ®9. INDUSTRIAL ®14. TIRES <br />®10. INERT ❑X 15. OTHER (describe): See Attachment 1 <br />F15. COMPOSTABLE MATERIAL (describe): <br />Page 1 <br />