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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 PERMITIWASTE DHreWed <br /> RGE REQUIREMENTS <br /> CIWMB E-1-77 Rev.8-04 <br /> NOTE:This form has been developed for multiple uses. It is the transmittal shee to be submitted to the appropriate agency. <br /> Please refer to the attached instructions for definitions of terms and for co I th kation form in a complete and correct manner. <br /> FOR OFFICIAL USE ONLY <br /> SWIS NUMBER: FILING FEE: RECEIPT NUMBER: DATE RECEIVED: <br /> DATE ACCEPTED: DATE REJECTED: ACCEPTANCE DATE OF <br /> INCOMPLETE APPLICATION: <br /> DATE DUE: <br /> Part 1.GENERAL INFORMATION <br /> A.ENFRCENE�/�� B.COUNTY: <br /> alwo <br /> C.TYPE OF APPLICATION(Check one box—only). <br /> 1. NEW SWFP and/or WDRS 04.PERMIT REVIEW <br /> 112. REVISION OF SWFP and/or WDRS 115.AMENDMENT OF APPLICATION <br /> 03. EXEMPTION and/or WAIVER E16.RFI/ROWD/JTD AMENDMENTS <br /> Part 2.FACILITY DESCRIPTION <br /> A. NAME OF FACILITY: <br /> Ana (n « del <br /> B COCATION OF FACILITY. <br /> 1. PHYSICA- ,DDRESS OR Lnr""--"Jr CODE: <br /> Slk,., �iZ- Sid �s q <br /> 2. LATITUDE AND LONGITUDE e J <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 /> t?"'DISPOSAL „j„��(�l "'Q � F__13.TRANSFORMATION M5.OTHER(describe): <br /> a <br /> TYPE: (f <br /> r� ;OMPOSTING M4.TRANSFER/PROCESSING FACILITY <br /> a. TYPE: 1 ❑CHECK HERE IF RECYCLABLE MATERIALS ARE RECOVERED PRIOR TO TRANSFER/PROCESSING, <br /> D.CONFORMANCE FINDING INFORMATION(CIWMP): <br /> ®1.FACILITY IS IDENTIFIED IN(Check one): <br /> SITING ELEMENT DATE OF DOCUMENT PAGE# <br /> �NONDISPOSAL FACILITY EL DATE OF DOCUMENT 15/1 a PAGE# <br /> 112.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 /> AGRICULTURAL F__16 CONSTRUCTION/DEMOLITION r'_j11.LIQUIDS <br /> ®2.ASBESTOS ❑Friable O Non-friable FIT CONTAMINATED SOILS E]12.MIXED/MUNICIPAL SOLID WASTE <br /> M3.ASH Q8.DEAD ANIMALS ❑13.SEWAGE SLUDGE <br /> M4.AUTO SHREDDER F-19.INDUSTRIAL n14.TIRES <br /> 10.INERT F_115.OTHER(describe): <br /> F�5.COMPOSTABLE MATERIAL(describe): <br /> Page 1 <br />