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STATE OF CALIFORNIA <br /> DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY <br /> REGIONAL WATER QUALITY CONTROL BOARD <br /> APPLICATION FOR SOLID WASTE FACILITY PERMIT AND WASTE DISCHARGE REQUIREMENTS <br /> CALRECYCLE E-1-77(Rev.11-15) <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 completing this application form in a complete and correct manner. <br /> FOR OFFICIAL USE ONLY <br /> WIS/WDID/Global ID NUMBER: FILING FEE: RECEIPT NUMBER: DATE RECEIVED: <br /> DATE ACCEPTED: DATE REJECTED: ACCEPTANCE DATE OF <br /> INCOMPLETE APPLICATION: <br /> DATE DUE: <br /> Part 1. GENERAL INFORMATION <br /> A.ENFORCEMENT AGENCY: B.COUNTY: <br /> San Joaquin County Environmental Health Department San Joaquin <br /> C.TYPE OF APPLICATION(Check one box only): <br /> F11. NEW SWFP and/or WDRS4.PERMIT REVIEW <br /> 2. CHANGE TO SWFP and/or WDRS r-1 5.AMENDMENT OF APPLICATION <br /> ❑REVISION ❑MODIFICATION ❑OTHER(As authorized by law) <br /> 03. WAIVER ❑ 6.RFI/ROWD/JTD AMENDMENTS <br /> Part 2. FACILITY DESCRIPTION <br /> A. NAME OF FACILITY: <br /> Central Valley Waste Services-SWIS 39-AA-0017 <br /> B. LOCATION OF FACILITY: <br /> 1. PHYSICAL ADDRESS OR LOCATION AND ZIP CODE: <br /> 1333 East Turner Road, P.O. Box 241001, Lodi, CA 95241 <br /> 2, LATITUDE AND LONGITUDE: <br /> N 38 degrees 08'41" W 12 degrees 15'11" <br /> 3. LEGAL DESCRIPTION OF PERMITTED BOUNDARY BY SECTION,TOWNSHIP,RANGE,BASE,AND MERIDIAN,IF SURVEYED: <br /> CA Northeast quarter of Section 6 T3N WE EMDB&M; Southeast quarter of Section 31 T4N WE EMDB&M; Northeast quarter of the <br /> northwest quarter of Section 6 T3N WE EMDB&M <br /> C.TYPE OF ACTIVITY:(Check applicable boxes): <br /> 1.DISPOSAL Q 3.TRANSFORMATION E-1 5.C&D/INERT DEBRIS PROCESSING <br /> a. TYPE: <br /> 17 2.COMPOSTABLE MATERIALS HANDLINGx� 4.TRANSFER/PROCESSING ® 6.IN-VESSEL DIGESTION <br /> a. TYPE: <br /> X❑ 7.OTHER(describe): Green Waste Hrocessing <br /> D.IDENTIFICATION OF FACILITY IN CIWMP[CONFORMANCE FINDING]: <br /> 0 1.FACILITY IS IDENTIFIED IN(Check one): <br /> ❑ SITING ELEMENT DATE OF DOCUMENT PAGE# <br /> -1 NONDISPOSAL FACILITY ELEMENT DATE OF DOCUMENT Revised March 2016 PAGE# 6 <br /> E.TYPE OF PERMITTED WASTES TO BE RECEIVED:(Check applicable boxes): <br /> x❑ 1.AGRICULTURAL D 6.CONSTRUCTION/DEMOLITION ❑ 11.LIQUIDS <br /> ❑ 2.ASBESTOS ❑Friable ❑ Non-friable E-1 7.CONTAMINATED SOILS X❑ 12.MUNICIPAL SOLID WASTE(MSW) <br /> ❑ 3.ASH ® 8.DEAD ANIMALS ❑ 13.SEWAGE SLUDGE <br /> ❑ 4.AUTO SHREDDER F-1 9.INDUSTRIAL x❑ 14.WASTE TIRES <br /> ® 10.INERT ❑ 15.OTHER(describe): <br /> x❑ 5.COMPOSTABLE MATERIAL(describe): Green Waste&Food Waste <br /> Page 1 <br />