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STATE OF CALIFORNIA CALIFORNIA INTEGRATED WA GEMENT BOARD <br /> REGIONAL WATER QUALITY CONTROL BOARD <br /> APPLICATION FOR SOLID WASTE FACILITY PERMITMASTE DISCHARGE REQUIREMENTS <br /> CIWMB E-1.77 Rev.6/96 <br /> ENFORCEMENT AGENCY: FOR OFFICIAL USE ONLY <br /> SWIS NUMBER WE RECFRW.- <br /> ING FEE: <br /> TYPE OF APPLUTION: CEIPT NUMBER: <br /> I=ACCEPTANCE OF <br /> Ell. NEW SWFP AND/OR WDRS 04.REVIEWCC40MPLETE APPLICATION: <br /> 132. REVISION OF SWFP AND/OR WDRS®5.AMENDMENT OF APPLICATION <br /> 1:13. EXEMPTION AND/OR WAIVER 1:16.RFI/ROWD/JTD AMENDMENTS ®7. CHANGE OF OWNER/OPERATOR OR ADDRESS <br /> NOTE:This form has been developed for multiple uses. It is the transmittal sheet for documents required to be submitted to the appropriate <br /> agency. See instructions for completing this application. <br /> L GENERAL A. NAME OF FACILITY: <br /> DESCRIPTION B. LOCATION OF FACILITY:(Give address or location,also Include legal description by section,township,range,base,and meridian If surveyed <br /> OF or projected.) <br /> FACILITY <br /> C.TYPE OF OPERATION:(Check applicable boxes.) <br /> ®DISPOSAL ®TRANSFORMATION ®SEWAGE TREATMENT <br /> TYPE: ®TRANSFER OR ®INDUSTRY(discharge to sewer) <br /> ®COMPOSTING PROCESSING STATION ®INDUSTRY(on-site disposal) <br /> TYPE: TYPE: ®OTHER(describe): <br /> D.COSWMP/CIWMP REFERENCES: <br /> DATE OF DOCUMENT: PAGES: <br /> E.TYPE OF WASTES TO BE RECEIVED:(Check applicable boxes.) <br /> ®AGRICULTURAL ®DEAD ANIMALS ®SLUDGE <br /> ®ASBESTOS ®FRIABLE-ASBESTOS ®TIRES <br /> ®ASH ®INDUSTRIAL ®WOOD MILL <br /> ®AUTO SHREDDER ®LIQUIDS ®OTHER:(describe) <br /> ®CONSTRUCTION/DEMOLITION ®MIXED MUNICIPAL <br /> II.FACILITY A.PROPOSED CHANGE (Check applicable boxes) <br /> INFORMATION ®DESIGN(describe) <br /> ®OPERATION(describe) <br /> ®OTHER(describe) <br /> B.FACILITY INFORMATION: <br /> PEAK DAILY LOADING AVERAGE ANNUAL SITE CAPACITY(yds): FACILITY SIZE(aces): <br /> (TPD): LOADING (TPY): <br /> DISPOSAL TOTAL WASTE IN PLACE(yds): AREA IN WHICH SOIL WILL BE DESIGN AIR SPACE CAPACITY: <br /> AREA: DISTURBED(acres): <br /> EXPECTED CLOSURE DATE: <br /> C. PRESENT OR PROPOSED: <br /> DAILY FLOW(in MGD): MAXIMUM: AVERAGE: DESIGN FLOW pn MGD): <br /> Ili SOURCE OF WATER SUPPLY(check all appropriate) <br /> A. MUNICIPAL OR UTILITY SERVICE: IB.INDIVIDUAL(wells) <br /> NAME OF WATER SURVEYOR C.SURFACE SUPPLY: <br /> NAME OF STREAM,LAKE,ETC <br /> TYPE OF WATER RIGHTS: ®RIPARIAN ®APPROPRIATION <br /> (OVER) <br /> ®IAA <br /> IV ENVIRONMENTAL IMPACT REPORT(EIR) <br /> HAS AN EIR BEEN PREPARED FOR THIS PROJECT? YES ®NO <br />