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A <br />Part 3. FACILITY INFORMATION <br />A. PROPOSED CHANGE (Check applicable box(es)): <br />F-11. DESIGN (describe): <br />F-12. OPERATION (describe): <br />M3. OWNER, OPERATOR, ADDRESS, AND/OR FACILITY NAME CHANGE (describe): <br />❑4. OTHER (describe): <br />B. FACILITY INFORMATION: <br />1. INFORMATION APPLICABLE TO ALL FACILITIES <br />a. PEAK DAILY TONNAGE OR CUBIC YARDS <br />1) DISPOSALITRANSER (unit) <br />2) OTHER (unit) <br />b. DAILY DESIGN TONNAGE (TPD) <br />c. FACILITY SIZE (acres) <br />d. PEAK TRAFFIC VOLUME PER DAY (vpd) <br />e. DAYS AND HOURS OF OPERATION <br />2. ADDITIONAL INFO. REQUIRED FOR COMPOSTING FACILITIES ONLY <br />a. SITE STORAGE CAPACITY (cu yds) <br />3. ADDITIONAL INFORMATION REQUIRED FOR LANDFILLS ONLY <br />a. AVERAGE DAILY TONNAGE (TPD) <br />b. SITE CAPACITY CURRENTLY PERMITTED (Airspace) (cu yds) <br />c. SITE CAPACITY PROPOSED (Airspace) (cu yds) <br />d. SITE CAPACITY USED TO DATE (Airspace) (cu yds) <br />e. SITE CAPACITY REMAINING (Airspace) (cu yds) <br />f. DATE OF CAPACITY INFORMATION (Date) (See instructions): <br />g. LAST PHYSICAL SITE SURVEY (Date) <br />h. ESTIMATED CLOSURE DATE (month and year) <br />I. DISPOSAL FOOTPRINT (acres) <br />j. SITE CAPACITY PLANNED (cu yds) <br />k. 1. (i) IN-PLACE WASTE DENSITY (Ibs of waste per cu yd of waste) <br />AND <br />(ii) WASTE -TO -COVER RATIO (Estimated) (v:v) <br />OR <br />2. AIRSPACE UTILIZATION FACTOR (tons of waste per cu yd of landfill airspace) <br />Part 4. SOURCE OF WATER SUPPLY (Check applicable boxes) <br />F_JA. MUNICIPAL OR UTILITY SERVICE: <br />®B. INDIVIDUAL (wells): <br />MC. SURFACE SUPPLY: <br />1. NAME OF STREAM, LAKE, ETC.: <br />2. TYPE OF WATER RIGHTS: <br />RIPARIAN APPROPRIATION <br />3. STATE PERMIT OR LICENSE NUMBER, IF APPLICABLE: <br />Page 2 <br />