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STATE OF CALIFORNIA CALIFORNIA INTEGRATj STE MANAGEMENT BOARD <br /> SOLID WASTE FACILITIES PERMIT APPLICATION <br /> CIWMB E•1•77(REV.x/921 <br /> ENFORCEMENT AGENCY: FOR ENFORCEMENT AGENCY USE ONLY <br /> FILE NUMBER IPERMIT NUMBER) OA TE RECEIVED: <br /> Public Health Services - Env. Health Div. DATE ACCEPTED: <br /> COUN TY: DA TE REJECTED: <br /> Sall Joaquin FILING FEE: <br /> TYPE OF APPLICATION: RECEIPT NUMBER: <br /> CO SWM%COUNTYWIDE <br /> ®t. NEW SOLID WASTE FACILITY PERMIT 4. MODIFICATION OF PERMIT ®7.AMENDMENT OF APPLICATION IWMP REFERENCE PAGEISI: <br /> a2. REVISION OF PERMIT _ S. EXEMPTION FROM PERMIT <br /> ❑3. PERMIT REVIEW �6. FACILITY CLOSURE <br /> NOTE:This form hes been developed for multiple uses. It is the transmittal sheet for documents required to be submitted to the <br /> local enforcement agency. See instructions for completing this application. <br /> L GENERAL NAME OF FACILITY: Scotts Sall JoggLlln <br /> DESCRIPTION LOCATION OF FACILITY: (Give address of location, also include legal description by section,township, lanae,base, and <br /> OF meridian If surveyed or projected. <br /> FACILITY <br /> TYPE OF FACILITY: ❑LANDFILL ®PROCESSING FACILITYMATERIAL RECOVERY FACILITY <br /> ❑SUMP ®TRANSFER STATIONLAND SPREADING <br /> TRANSFORMATION ®COMPOSTING (Yard Trimmings) <br /> FACILITY <br /> TYPE OF WASTES TO BE RECEIVED: <br /> 17 AGRICULTURAL ®DEAD ANIMALS �TIRES <br /> aAS8ESTOS ®INDUSTRIAL ®W000 MILL <br /> r7ASH ®LIQUIDS IINCLUOES SEPTAGE) QOTHER DESIGNATED WASTE <br /> AUTO SHREDDER ®MIXED MUNICIPAL OTHER HAZARDOUS WASTE <br /> OCONSTRUCTION/DEMOLMON ®SLUDGE ®OTHER: (DESCRIBE) TrirrTnir.. <br /> If. FACILITY PROPOSED CHANGE EFFECTIVE DATE <br /> INFORMATION COMMENCED (CHECK APPLICABLE SOXES1 OF PROPOSED CHANGE: <br /> Oats: ®DESIGN <br /> ®WILL COMMENCE ®NO CHANGE <br /> Date:October 1994* <br /> ®OPERATION <br /> AVERAGE ANNUAL PEAK DAILY FACILITY SITE CAPACITY EXPECTED CLOSURE DATE: <br /> LOADINGO'FY): ** LOADINGfTPo): 500 SIZE W: 22 acres I IN YARDS: S5 0QQssa Indefiniteiv <br /> 111. OPERATOR OWNER OF LAND ADDRESS: TELEPHONE NUMBER: <br /> INFORMATION IN.mel: 23390 Flood Road <br /> For land disposal, Scotts H nex Linden CA 95236 209 887- <br /> If operator Ia FACILITY OPERATOR ADDRESS:23390 Flood Road <br /> dlffanrtt from (Namel: <br /> land ay.n.r. .ttach cctts/H nex Linden, CA 95236 (209) 887-3845 <br /> (ease ar franchise ADDRESS WHERE LEGAL NOTICE MAY BE SERVED: TELEPHONE NUMBER: <br /> agmemant. Same as Facility rator <br /> I hereby acknowledge that I have read this application and the Report of Facility Information, and cartity that the information given is <br /> true and accurate to the best of my knowledge and belief. In operating the solid waste facility, 1 agree to comply with the conditions <br /> of the permit and with federal, state, and local enactments. <br /> SIGNATURE(LAND OWN OAGENT)* / SIGNA RE!FACILITY OPERATOR 08 GENT): <br /> TYPED NAME: TYPED NA-M96. r <br /> 2. Daucherty Gary L. Dau he <br /> TITLE:' ` r V DATE: 1 G — Tr7LE- ' ` - DATE: <br /> saga- <br /> IV.LIST OF ATTACHMENTS (CHECK IF APP ICASLE): <br /> ©REPORT OF FACILITY INFORMATION ®SWAT(AIR AND WATERI <br /> PERIODIC SITE REVIEW �STORMWATER OISCHARGE PERMITS INPOES) <br /> ❑ <br /> X LOCAL USE/PLANNING PERMITS OWETLANDS PERMIT <br /> 7OPERATING LIABILITY FINANCIAL MECHANISM ®PRELIMINARY CLOSURE/POSTCLOSURE MAINTENANCE PLAN <br /> MOEPARTMENT OF HEALTH SERVICES PERMIT ®FINAL CLOSURE/POSTCLOSURE MAINENANCE PLAN <br /> Exempt AIR QUALITY/POLLUTION CONTROL DISTRICT PERMrT1 aFINANCIAL RESPONSIBILITY DOCUMENTATION <br /> 17 CERTIFIED ENVIRONMENTAL REVIEW REPORTS (CEQAI ®OTHER REGULATORY AGENCY PERMITS <br /> Exempt 17 WASTE DISCHARGE REQUIREMENTS ®OTHER Pro )e y Deed <br /> IPEAMIT.XISa/921 * Or when LEA issues SWFP <br /> ** 75 ,000 TPY <br />