Laserfiche WebLink
STATE OF CALIFORNIA • • <br /> CALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD <br /> REGIONAL WATER QUALITY CONTROL BOARD <br /> APPLICATION FOR SOLID WASTE FACILITY PERMITMASTE 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 /> ATE ACCEPTED: DATE REJECTED: ACCEPTANCE DATE OF <br /> INCOMPLETE APPLICATION: <br /> DATE DUE: <br /> Part 1.GENERAL INFORMATION <br /> A.ENFORCEMENT AGENCY: COUNTY: <br /> C ' B. <br /> c5a)n Non <br /> C.TYPE OF APPLICATION(check one box onW: <br /> M 1. NEW SWFP and/or WDRS 114.PERMIT REVIEW <br /> n(2. REVISION OF SWFP and/or WDRS ❑5.AMENDMENT OF APPLICATION <br /> 17CI3. EXEMPTION and/or WAIVER 116.RFI/ROWD/JTD AMENDMENTS <br /> Part 2.FACILITY DESCRIPTION <br /> A. NAME OF FACILITY: <br /> Foy-wu -J tic <br /> B. LOCATION OF FACILITY: <br /> 1. PHYSICAL ADDRESS OR LOCATION AND ZIP CODE: <br /> lolof S. Pf utAn 'Doo-4 <br /> 2. LATITUDE AND LONGITUDE: <br /> 3. LEGAL DESCRIPTION OF PERMITTED BOUNDARY BY SECTION,TOWNSHIP,RANGE,BASE,AND MERIDIAN,IF SURVEYED: <br /> C.TYPE OF ACTIVITY:(Check applicable boxes): <br /> M1.DISPOSAL [-]3.TRANSFORMATION 1,J15.OTHER(describe): <br /> a. TYPE: <br /> M2.COMPOSTING 04.TRANSFERIPROCESSING FACILITY <br /> a. TYPE: 0 CHECK HERE IF RECYCLABLE MATERIALS ARE RECOVERED PRIOR TO TRANSFER/PROCESSING. <br /> D.CONFORMANCE FINDING INFORMATION(CIWMP): <br /> F-11.FACILITY IS IDENTIFIED IN(Check one): <br /> SITING ELEMENT DATE OF DOCUMENT PAGE# <br /> r-1NONDISPOSAL FACILITY EL DATE OF DOCUMENT PAGE# <br /> t2.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 /> M1.AGRICULTURAL F-16.CONSTRUCTIONIDEMOLITION M11.LIQUIDS <br /> M2.ASBESTOS 0 Friable 0 Non-friable F-17.CONTAMINATED SOILS M12.MIXEDIMUNICIPAL SOLID WASTE <br /> M&ASH M8.DEAD ANIMALS 13.SEWAGE SLUDGE <br /> ❑4.AUTO SHREDDER 09.INDUSTRIAL 14.TIRES <br /> r-110.INERT 015.OTHER(describe): <br /> M5.COMPOSTABLE MATERIAL(describe): <br /> Page 1 <br />