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dart3. FACILITY INFORMATION <br /> A.PROPOSED CHANGE(Check applicable box(es)): <br /> MI.DESIGN(describe): <br /> ❑2.OPERATION(describe): <br /> 1:13. OWNER,OPERATOR,ADDRESS, <br /> AND/OR FACILITY NAME CHANGE(describe): ' <br /> qf4.OTHER(describe): NieG{/ ;�,�Q�/o/ pgs1wy <br /> 7 - -/ �.+ <br /> .�r7,e <br /> B.FACILITY INFORMATION: <br /> 1.INFORMATION APPLICABLE TO ALL FACILITIES: / <br /> a. PEAK DAILY TONNAGE OR CUBIC YARDS ��„� l/j�ieAILS <br /> 1) DISPOSAUTRANSER(unit) <br /> 2) OTHER(unit) <br /> b. DAILY DESIGN TONNAGE(TPD) <br /> c. FACILITY SIZE(acres) <br /> d. PEAK TRAFFIC VOLUME PER DAY(vpd) V U$h! <br /> e. DAYS AND HOURS OF OPERATION ya OsJ a4z f A ,-/E'✓ �N/ f./® !G� <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) o A 7 <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 /> MA. MUNICIPAL OR UTILITY SERVICE: <br /> I/{.IB.INDIVIDUAL(welis): _ ,egrG& 7"Rue_ `/®lv f�Q47G <br /> r`"` C.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 />