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r 0 0 <br /> STATE OF CALIFORNIA <br /> CALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD <br /> REGIONAL WATER QUALITY CONTROL BOARD <br /> APPLICATION FOR SOLID WASTE FACILITY PERMIT/WASTE DIRre <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 ed tobe submitted to the appropriate agency. <br /> Please refer to the attached instructions for definitions of terms and for co k t cation 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.ENFQRCEMENTAGE6AEA <br /> S.COUNTY: <br /> lXl •��UkC v d r)6sy'r1 <br /> C TYPE OF APPLICATION(Check one box only): <br /> ❑1 NEW SWFP and/or WDRS 04.PERMIT REVIEW <br /> FTREVISION OF SWFP and/or WDRS 05.AMENDMENT OF APPLICATION <br /> 113. EXEMPTION and/or WAIVER E16.RFI/ROWD/JTD AMENDMENTS <br /> Part 2. FACILITY DESCRIPTION <br /> A. NAME OF FACILITY: <br /> AV <br /> B. LOCATION OF FACILITY: <br /> 1. PHYSICA DORESS OR LOr°-.-..'vr '^CODE: <br /> Ste„ `�6nv `�Z• S go-76 s 7 <br /> 2. LA �LONGffUDE <br /> 3. LEGAL DESCRIPTION OF PERMITTED BOUNDARY BY SE �1 <br /> C.TYPE OF ACTIVITY:(Check applicable boxes): yA//ej7 <br /> t?"DISPOSAL (�7 �d4 [::]3.TRPv— <br /> a <br /> TYPE: RJI� <br /> r-- . .._...._. <br /> _.„OMPOSTING Y �4.TRF <br /> a. TYPE: 0"�� ❑CH <br /> D.CONFORMANCE FINDING INFORMATION(CIWMI <br /> 1 FACILITY IS IDENTIFIED IN(Check one): <br /> SITING ELEMENT ....._._._.-_._.._—_._—.__ .. PAGE# <br /> �NONDISPOSAL FACILITY EL PAGE# <br /> 2.FACILITY IS NOT REQUIRED TO BE IDENTIFIED IN SI- <br /> E.TYPE OF PERMITTED WASTES TO BE RECEIVE[----------------- <br /> 5/AGRICULTURAL <br /> ECEIVE[--- ------AGRICULTURAL a6 CO <br /> F-12.ASBESTOS ❑Friable ❑Non-friable F-17.CO <br /> F�3.ASH �8.DE. <br /> F-14.AUTO SHREDDER E-19,INC <br /> 10.IN= i Uio.vinen(oescrroe(� <br /> M5.COMPOSTABLE MATERIAL(describe). <br /> Page 1 <br />