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INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR SOLID WASTE FACILITY PERMITMASTE DISCHARGE REQUIREMENTS (NEW Permit Application Form CIWMB E-1-77, Revised 8/2004, Effective 1/1/2005) This application form is for a Solid Waste Facility Permit(SWFP)and/or Waste Discharge Requirements(WDRs)to receive, store, process,transform, or dispose of solid waste regulated by the California Integrated Waste Management Board(CIWMB)/Local Enforcement Agency(LEA)and the California Regional Water Quality Control Boards(RWQCB). The application is to be used for both new and revised permits, and expansions. All applications must be filled out completely. Check with local or county enforcement agency for specific permit requirements and/or exemptions. This form and the filing fee should be sent to the appropriate agency(ies) indicated below: FORM TYPE/USE APPROPRIATE AGENCY Application for a Solid Waste Facility Permit CIWMB/LEA Report of Waste Discharge/WDRs RWQCB If you have any questions on the completion of this form, please contact the appropriate agency(ies)for assistance. You can download this form from the CIWMB website at http://www.ciwmb.ca.gov/LEACentral. For direct discharge(point source discharge)to surface waters, a different application form is required in place of this form. Please contact the appropriate Regional Water Quality Control Board for a National Pollutant Discharge Elimination System(NPDES) application form to apply for a permit for this type of discharge. The Application for Solid Waste Facility Permit/Waste Discharge Requirements provides initial notice of a waste discharge. In most instances, additional information will be required, and should be submitted on 8'/Z"X 11"paper. Submit two copies of the completed form and of any required report(s), and filing fee to the Enforcement Agency(EA). Submit one copy of the form and any required report and filing fee to the RWQCB. The agency(ies)will advise you of any additional information that may be required to complete this application and waste disposal report. You will be notified of the effective date of the application by each agency. AMOUNT OF FILING FEES • EA-The enforcement agencies shall determine the exact fee. • RWQCB- Use flow or units reported in Part 4(application form)and the appropriate class schedule A, B, 61, B3, or C (attached filing fee schedule). FOR OFFICIAL USE ONLY (CIWMB/LEA/RWQCB staff) SWIS Number: The Solid Waste Information System (SWIS) number assigned to the facility by CIWMB staff. Filing Fee: The amount of filing fee submitted by the applicant. Receipt Number: The number assigned to the application by CIWMB/LEA/RWQCB staff. Date Received: The date the application package is received from the applicant(Title 27, section 21650(a)). Date Accepted: The date the EA accepts application package for filing (Title 27, section 21650(a)). Date Rejected: The date the EA determines that the application package is rejected (Title 27, section 21650(d)). Date Acceptance of Incomplete Application: The date the EA accepts an application package as incomplete(Title 27, section 21580) Due Date: 180 days from the date the application was accepted as incomplete(Title 27, section 21580). Page 1