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STATE OF CALIFORNIA <br /> CALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD <br /> REGIONAL WATER QUALITY CONTROL BOARD <br /> APPLICATION FOR SOLID WASTE FACILITY PERMIT/WASTE DISCHARGE REQUIREMENTS <br /> CIWMB E-1-77(Rev.8-04) <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 /> SWIS NUMBER: /�/� FILING FEE: RECEIPT NUMBER: DATE RECEIVED: <br /> 3 9--!f _ QOo2y 3/s 113 <br /> DATE ACCEPTED: DATE REJECTED: ACCEPTANCE DATE OF <br /> INCOMPLETE <br /> APPLICATION. <br /> DATE DUE: <br /> Part 1.GENERAL INFORMATION <br /> A.ENFORCEMENT AGENCY: B.COUNTY: <br /> Coun of San Joaquin,Environmental Health Department San Joaquin <br /> C.TYPE OF APPLICATION(Check one box only): <br /> ❑1. NEW SWFP and/or WDRS 04.PERMIT REVIEW <br /> X12. REVISION OF SWFP and/or WDRS 05.AMENDMENT OF APPLICATION <br /> 113. EXEMPTION and/or WAIVER 116.RFI/ROWD/JTD AMENDMENTS <br /> Part 2.FACILITY DESCRIPTION <br /> A. NAME OF FACILITY: <br /> Tracy Material Recovery&Transfer Facility <br /> B. LOCATION OF FACILITY: <br /> 1. PHYSICAL ADDRESS OR LOCATION AND ZIP CODE: <br /> 30703 S Macarthur Drive Tracy CA 95376 <br /> 2. LATITUDE AND LONGITUDE: <br /> Lat 37 67803 North, Long-121.41618 West <br /> 3. LEGAL DESCRIPTION OF PERMITTED BOUNDARY BY SECTION,TOWNSHIP,RANGE,BASE,AND MERIDIAN,IF SURVEYED: <br /> n/a <br /> C.TYPE OF ACTIVITY:(Check applicable boxes): <br /> �1.DISPOSAL �3.TRANSFORMATION El 5.OTHER(describe): Cannery Waste <br /> a. TYPE: <br /> XM2.COMPOSTING M74.TRANSFER/PROCESSING FACILITY <br /> Green Waste/ X CHECK HERE IF RECYCLABLE MATERIALS ARE RECOVERED PRIOR TO TRANSFER/PROCESSING. <br /> a. TYPE: Food Waste <br /> D.CONFORMANCE FINDING INFORMATION(CIWMP): <br /> X�1.FACILITY IS IDENTIFIED IN(Check one): <br /> EDITING ELEMENT DATE OF DOCUMENT Mar-97 PAGE# <br /> FINONDISPOSAL FACILITY EL DATE OF DOCUMENT PAGE# <br /> R2.FACILITY IS NOT REQUIRED TO BE IDENTIFIED IN SITING ELEMENT OR NONDISPOSAL FACILITY ELEMENT <br /> E.TYPE OF PERMITTED WASTES TO BE RECEIVED:(Check applicable boxes): <br /> R 1.AGRICULTURAL X16.CONSTRUCTION/DEMOLITION n11.LIQUIDS <br /> n2.ASBESTOS ❑Friable❑Non-friable 17.CONTAMINATED SOILS R 12.MIXED/MUNICIPALSOLID WASTE <br /> F-13.ASH 08.DEAD ANIMALS F-113.SEWAGE SLUDGE <br /> M4.AUTO SHREDDER E19.INDUSTRIAL X❑14.TIRES <br /> L110.INERT X�15.OTHER(describe): Appliances, u-waste,a-waste <br /> X15.COMPOSTABLE MATERIAL(describe): Green Waste,Food Waste <br /> Page 1 <br />