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no [vvr �[D <br /> n <br /> STATEOFCALIFORNIA FEBC 2007 <br /> CALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD <br /> REGIONAL WATER QUALITY CONTROL BOARD ENT L C n f T H <br /> APPLICATION FOR SOLID WASTE FACILITY PERMITIWASTE DISCHARGE REQUIR IS 8 ICr1�L!F t <br /> CIWMB E-1d7(Rev.844 a <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 definifions of terms and for completing this application form in a complete and Correct manner. <br /> FOR OFFICIAL USE ONLY <br /> SWIS NUCM�BER: FILING FEE: RECEIPT NUMBER: DATE RECEIVED: <br /> TE ACCEPTED: DATE REACTED: ACCEPTANCE DATE OF <br /> INCOMPLETE APPLICATION: <br /> S^ Z^ c> DATE DUE: <br /> Part 1.GENERAL INFORMATION <br /> A ENFORCEMENT AGENCY: 1 r Lr B.COUNTY: <br /> �'®'� '✓'°aw.w -�'to+� G.o.ITL a.. ....�04 c+i.� �°-T <br /> C. <br /> TYPE OF APPLICATION(Check one box only): <br /> 1. NEW SWFP and/or WDRS ®4.PERMIT REVIEW <br /> ❑2. REVISION OF SWFP and/or WDRS ®5.AMENDMENT OF APPLICATION <br /> 1:13. EXEMPTION and/or WAIVER ®6.RFI/ROWDIrrDAMENDMENTS <br /> Part 2.FACILITY DESCRIPTION <br /> A. NAME OF FACILITY: <br /> ,$� s 5 e��rm®n/ CvvNTy R �ruA�A L C®A�Pvs J't� F�Gf L. <br /> B. LOCATION OF FACILITY. <br /> 1. PHYSICAL ADDRESS OR LOCATION AND ZIP CODE: <br /> 233 ® FL-004 R®AJ , LOAsderAl CA 952.36 <br /> 2. LATITUDE AND LONGITUDE: <br /> ,3'18 0® 24, 9,Z/J IZI 01 37 .53 14/ <br /> 3, LEGAL DESCRIPTION OF PERMITTED BOUNDARY BY SECTION,TOWNSHIP,RANGE,BASE,AND MERIDIAN.IF SURVEYED: <br /> Ste€ <br /> AMI C It Fd f WIA 60A4P6)S7/Al � byuA,,,dA--16 <br /> C.TYPE OF ACTIVITY:(Check applicable boxes): <br /> M1.DISPOSAL 03.TRANSFORMATION E]6.OTHER(describe): <br /> a. TYPE: <br /> ®2.COMPOSTING a4.TRANSFERIPROCESSING FACILITY <br /> a.TYPE: 69e&V i/®�J-C`?2/i} 0 CHECK HERE IF RECYCLABLE MATERIALS ARE RECOVERED PRIOR TO TRANSFER/PROCESSING. <br /> D.CONFORMANCE FINDING INFORMATION(CIWMP): <br /> 01.FACILITY IS IDENTIFIED IN(Check one): <br /> SITING ELEMENT DATE OF DOCUMENT PAGE# <br /> NONDISPOSAL FACILITY ELEfAetJ T DATE OF DOCUMENT L4AY 5 ZOO?- PAGE# Z <br /> 112.FACILITY ISNOT REQUIRED TO BE IDENTIFIED IN SITING ELEMENT OR NONDISPOSAL FACILITY ELEMENT <br /> E.TYPE OF PERMITTED WASTES TO BE RECEIVED:(Check applicable boxes): <br /> MI.AGRICULTURAL pe.CONSTRUCTIOWDEMOLRION ®11.LIQUIDS <br /> [72.ASBESTOS 0 Friable 17 Non-friable [:]7.CONTAMINATED SOILS ®12.MIXED/MUNICIPAL SOLID WASTE <br /> E]3.ASH ®8.DEAD ANIMALS ®13.SEWAGE SLUDGE <br /> ❑4.AUTO SHREDDER M9.INDUSTRIAL ®14.TIRES <br /> MID.INERT ®�®16.OTHER(describe): <br /> 05.COMPOSTABLE MATERIAL(desaibe): n/ ,@R-,'T/is FSyF A.* 1A I-S (S X- ;fe' d <br /> Page 1 <br />