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01 <br />STATE OF CALIFORNIA <br />DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY <br />REGIONAL WATER QUALITY CONTROL BOARD <br />APPLICATION FOR SOLID WASTE FACILITY PERMIT AND WASTE DISCHARGE REQUIREMENTS <br />CALRECYCLE E-1-77 (Rev. 11-15) <br />NOTE: This form has been developed for multiple uses. It is the transmittal sheet for documents required to be submitted to the appropriate agency. <br />Please refer to the attached instructions for definitions of terms and for comnletino this annlication form in a comDlete and correct manner. <br />FOR OFFICIAL USE ONLY <br />SWIISNVDID/Global ID NUMBER <br />FILING FEE <br />RECEIPTNUMBER: <br />DATE RECEIVED: <br />6. CONSTRUCTION/DEMOLITION ❑ <br />5 <br />J 7%6.31 <br />r <br />/ <br />ATE ACCEPTED: <br />DATE REJECTED: <br />ACCEPTANCE DATE OF <br />-7 <br />3. ASH <br />INCOMPLETE APPLICATION: <br />DATE DUE: <br />8. DEAD ANIMALS r__j <br />13. SEWAGE SLUDGE <br />0 <br />Part 1. GENERAL INFORMATION <br />A. ENFORCEMENT AGENCY: <br />Environmental Health <br />>eck one box only): <br />1:1 1. NEW SWFP and/or WDRS <br />2. CHANGE TO SWFP and/or WDRS <br />❑ REVISION ❑ MODIFICATION <br />®3. WAIVER <br />Part 2. FACILITY DESCRIPTION <br />A. NAME OF FACILITY: <br />nt <br />❑ OTHER (As authorized by law) <br />Central Valley Waste Services - SW IS 39 -AA -0017 <br />B. LOCATION OF FACILITY: <br />1. PHYSICAL ADDRESS OR LOCATION AND ZIP CODE: <br />1333 East Turner Road, P.O. Box 241001, Lodi, CA 95241 <br />2. LATITUDE AND LONGITUDE: <br />N 38 degrees 08'41" W 12 degrees 15' 11" <br />COUNTY: <br />n 4. PERMIT REVIEW <br />5. AMENDMENT OF APPLICATION <br />❑ 6. RFI/ROWD/JTDAMENDMENTS <br />3. LEGAL DESCRIPTION OF PERMITTED BOUNDARY BY SECTION, TOWNSHIP, RANGE, BASE, AND MERIDIAN, IF SURVEYED: <br />CA Northeast quarter of Section 6 T3N R7E EMDB & M; Southeast quarter of Section 31 T4N R7E EMDB & M; Northeast quarter of the <br />northwest quarter of Section 6 T3N R7E EMDB & M <br />C. TYPE OF ACTIVITY: (Check applicable boxes): <br />1. DISPOSAL 0 3. TRANSFORMATION ❑ 5. C&D/INERT DEBRIS PROCESSING <br />a. TYPE: <br />2. COMPOSTABLE MATERIALS HANDLING x0 4. TRANSFER/PROCESSING <br />a. TYPE: <br />D. IDENTIFICATION OF FACILITY IN CIWMP [CONFORMANCE FINDING]: <br />® 1. FACILITY IS IDENTIFIED IN (Check one): <br />❑ SITING ELEMENT DATE OF DOCUMENT <br />x❑ NONDISPOSAL FACILITY ELEMENT DATE OF DOCUMENT <br />Revised March 2016 <br />❑ 6. IN -VESSEL DIGESTION <br />x❑ 7. OTHER (describe): Green Waste Processing <br />PAGE # <br />PAGE # 6 <br />E. TYPE OF PERMITTED WASTES TO BE RECEIVED: (Check applicable boxes): <br />X❑ <br />1. AGRICULTURAL <br />x� <br />6. CONSTRUCTION/DEMOLITION ❑ <br />11. LIQUIDS <br />2. ASBESTOS ❑ Friable n Non -friable <br />F_� <br />7. CONTAMINATED SOILS xx <br />12. MUNICIPAL SOLID WASTE (MSW) <br />0 <br />3. ASH <br />F__j <br />8. DEAD ANIMALS r__j <br />13. SEWAGE SLUDGE <br />0 <br />4. AUTO SHREDDER <br />F__j <br />9. INDUSTRIAL x❑ <br />14. WASTE TIRES <br />® <br />10. INERT ❑ <br />15. OTHER (describe): <br />R <br />5. COMPOSTABLE MATERIAL (describe): <br />Green Waste & Food Waste <br />Page 1 <br />