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'ATE OF CALIFORNIA CALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD <br /> REGIONAL WATER QUALITY CONTROL BOARD <br /> t PPLICATION FOR SOLID WASTE FACILITY PERMITMASTE DISCHARGE REQUIREMENTS <br /> NMB E-1-77 Rev.eWm% <br /> WIN <br /> IFORCEMENTAGENCY: OR OFFICIAL USE ONLY <br /> S NUMBER <br /> JN: 13ER: <br /> 1, NEW SWFPAND/OR MRS ACCEPTARCE OF <br /> E] REVIEW NCOMPLETP APPLICATION: <br /> 12. REVISION OF SWFP AND/OR WDRS[35.AMENDMENT OF APPLICATION <br /> 13. EXEMPTION AND/OR WAIVER 06.RFVROWWjTD AMENDMENTS 7. CHANGE OF OWNERIOPERATOR OR ADDRESS <br /> )TE:This form has been developed for multiple uses. It is the transmittal sheet for documents required to be submitted to the appropriate <br /> en , See instructions for compietin this applicationMae. <br /> e <br /> :ENERAL A. NAME OF FAciL1TY: ! <br /> SCRIPTION B. LOCATION OF FACILJTY:(Give address or bcatlon,also i1A <br /> udQlegal descri`ptigon by io(r�,,[township,range,base,and merldlan If gun-eyed <br /> or projected.) F c3 t ��jtr ` X11! „1 J <br /> • cIUTY c3� >� p 1 <br /> UO <br /> C_TYPE OF OPERATION:(Check applicable boYoc.) <br /> DISPOSAL []TRANSFORMATION ®SEWAGE TREATMENT <br /> TYPE' TRANSFER OR ®INDUSTRY(diacharge to Server) <br /> ®COMPOSTING PROCESSING STATION ®INDUSTRY(on-site dlsposal) <br /> TYPE: TYPE: OTHER(describe): <br /> D. SWMP/CIWMP REFERENCES! f <br /> DATE OF DOCUMENT: <br /> E.TYPE OF WASTES TO BE RECEIVED:(ChKk applicable boxw) PAGES: <br /> AGRICULTURAL DEAD ANIMALS <br /> SLUDGE <br /> SBESTOS FRIABLE-ASBESTOS []TIRES <br /> ASH WDUSTRAL <br /> WOOD MILL <br /> AUTO SHREDDER LIQUIDS <br /> ®OTHER:(deSCnbe)_ <br /> e e <br /> ®CONSTRUCTIONIDEMOLITION MIXED MUNICIPAL <br /> I CWTY A.PROPOSED CHANGE (Check applicable boxes) <br /> t RMATION ®DESIGN(desWbe) <br /> OPERATION(desplbe)_ C Ica Nh D!. �`1_ Y�� <br /> ®OTHER(describe) <br /> B.FACILITY INFORMATION: <br /> PEAK DAILY LOADING VERAGE ANNUAL <br /> (-rPD): SITE CAPACITY(yft); <br /> LOADING (TPY); FACILITY SIZE(arms): <br /> DISPOSAL TOTAL"MIN PLACE(yds): REAlN WHICH SOIL WILL BE <br /> AREA: DESIGN AIR SPACE CAPACITY: <br /> EXPECTED CLOSURE DATE: ®ISTUR®ED(apes); eZ.ZS <br /> C. PRESENT OR PROPOSED! <br /> DAILY FLOW on MGD): MAXIMUM: AVERAGE: <br /> DESIGN FLOW(in MGD): <br /> AUNIsOURCE OF WATER SUPPLY(Check all appropriate) <br /> CIPAL OR UTILITY$ERVICE: e.INDlV10UAL(we11s) <br /> tE OF WATER SURVEYOR SURFA <br /> SUPPLY.- <br /> NAME <br /> LY:NAME OF STREAM.LAKE.ETC <br /> TYPE OF WATER RIGHTS: RIPARIAN <br /> PROPRATION <br /> (OVER) <br /> ®® e <br /> IV ENVIRONMENTAL IMPACT REPORT(e!R) <br /> f 'kN EIR BEEN PREPARED FOR THIS PROJECT? <br /> ES [�NO <br /> 0/£0 39Vd NIIHVW 30E' 8 80860Z £9:61 b00Z/£0/90 <br /> 0 <br />