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<br /> INSTRUCTONS FOR COMPLETING THE AMNNICATI�� �- �� '
<br /> This application form isfor uSolid Waste Facilities Permit|oreceive,store,process,n/dispose u(solid wastes regulated bythe California Waste Management
<br /> '
<br /> Board(Board).This form and the filing fee should be sent to the appropriate city or county Local Enforcement Agency(LEA).The exact amount of the filing tee is
<br /> determined by the LEA.
<br /> Complete this form and return it with a photocopy and two copies of the appropriate attachments determined to be necessary byyour LEA.All material should bu
<br /> submitted uo81/2"xl1" paper. Maps and other oversize documents should bofolded 10that size.
<br /> The effective date the application is the all required information and the correct fee are received bythe LEA.The LEA will ooiifyynuo[this effective
<br /> date.
<br /> It you questions onthe completion ofthis form, please contact the LEA orBoard staff for assistance at(018) 3%2'333O.
<br /> NO iO8tDuCtiUASVYillhe listed'for items that are s8tf-8Np|8RGtQq/.
<br /> [ GENERAL DESCRIPTION OF FACILITY
<br /> TYPE OFWASTES TO BE RECEIVED:
<br /> agricultural—wastes resulting from the production and processing of farm or agricultural products, including animal manures,prunings,and crop residues-
<br /> asbestos--unatumUyucnuningfami|yufouminogenichbmuomioem!oub*unou.ThuSkatoDapurtmentofHeuhhSemi:nxhumdonoifiedthah/mwmstexwhich
<br /> contain more than one percent asbestos byweight oohazardous wastes.Friable means that the material can bocrumbled with pressure and,therefore,iulikely N
<br /> emit fibers.
<br /> ash --the residue from the incineration of solid wastes, including municipal waste, infectious waste, woodwaste, sludge, and agricultural wastes.
<br /> auto shrgddR|--tho 'Y|ufy' ouoxkging of uphn|strK paint, plastics, and other non-metallic substances which remains after the shredding of automobiles,
<br /> discarded household major appliances, and sheetmetal.The State Department of Health Services has classified untreated shredder wastes as hazardous.
<br /> CoHstnUC1iOO/de0Oii1iUQ wastes -- waste building materials, packaging and rubble mxo|tiny from constm*iou, remodeling, repair, and demolition
<br /> operations, and consisting mainly ufinert materials.
<br /> dead animals--animal oamuosno requiring disposal that have not been previously used for medical purposes or with known infectious diseases-
<br /> industrial—solid or semi-solid wastes resulting from industrial processes and manufacturing operations, e.g.,cement kiln dust,ore process residues, grit or
<br /> ioeaxom-iAdUSt[iQl--ouUdorxomi'uo|idwustoomou|dngfmmindusthalpm0000eoonUmaoufactuhngopomtinns, e4'oemeniAUnduot,nmpmoomsmoNuos' yn\m
<br /> screenings removed from owaste water treatment facility, etc.
<br /> infectious VVQSt8S --wmu{oxwhioh have disease transmission potential are classified as hazardous wastes by the State Department of Health Services-
<br /> Infectious wastes include:pathological and surgical wastes,medical clinic wastes,wastes from biological laboratories,syringes,needles,blades,whing, bags,
<br /> emicns-|nfucdouowustesioo|udo:putho|o0|ou/unduur0ioa|mmutmo.modi:u|diniowaotuo.waxtoxfmmbin|og/co!|ubomiahoo.xyringes.need|ps.h|ados./obioy. hags'
<br /> bottles, drugs, patient care items such as linen or personal or food service items from contaminated areas, chemicals, personal hygiene wastes, and animal
<br /> carcasses used for medical pu/pnouo or with known infectious diseases.
<br /> liquids—wastes which are not spadeable,usually containing less than 50 percent solids.These wastes include cannery and food processing wastes, landfill
<br /> leachate and gas condensate,boiler blowdown water,grease trap pumpings,oil and geothermal field wastes,septic tank pumpings,rendering plant byproducts, �
<br /> some sewage sludge, n{x. may be hazardous.
<br /> mixed municipal--mo|dundu|und:nmmomiu|refuse,garbage and/or rubbish.Residential waste is commonly thought of as household garbage,-commercial �
<br /> wmm10 contains less pNmoib|e waste and more paper and oauNauwd. �
<br /> sewage sludge—human(not industrial)residue,excluding grit or screenings,removed from a waste watertreatment facility or septic tank,whether in a dry or
<br /> semidry form.
<br /> tires --discarded tire casings.
<br /> wood mill—shavings,sawdust,sanderdust,chips,bark,slabs,dock scrapings,edgings,wood and otherflammable waste material incidental to the processing
<br /> of wood products.
<br /> UL FACILITY INFORMATION -
<br /> PROPOSED CHANGE IN DESIGN OR OPERATION, OR NO CHANGE; EFFECTIVE DATE:
<br /> For existing permitted facilities,when the operator proposes changes in design,operation,operator,or owner,details of the changes must basent/uthe LEA.h
<br /> significant,the pomni\must he revised prior to implementation of the change. Foran application for permit evioxx if there are no changes, nn indicate.
<br /> ,
<br /> AVERAGE ANNUAL LOADING (TPY):
<br /> The ummmgn amount ofwastes the facility receive on u yearly basis over the next five years, mmpm000d in\uoo. Most be consistent with the AR and 'any
<br /> California Environmental Duality Act(CEGA)requirements.Volume figures should be converted to tons and the conversion factor should he documented in the
<br /> accompanying Report nfFacility Information.
<br /> PEAK DAILY LOADING (TPO):
<br /> The maximum amount ofwaste the facility isdesigned 10receive, store, process, mdispose ofper day, expressed intons.
<br /> FACILITY SIZE:
<br /> The area ofthe facility inuoeo\ohyused kxmoekjog,storing,processing, dhp000gofwastes,including all monitoring locations and anybx#mmnx.This will
<br /> be referred to as the "permitted uumaAo^ and is considered the facility boundaries.
<br /> Ni OPERATOR INFORMATION
<br /> For land disposal operations,if operator is different from land owner, attach lease or franchise agreement documenting operator's interest in the real property.
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