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z <br /> STATF. Ut rALIFCRNIA SOLID +4 ASlE MANAGEMENT BOARD <br /> SOLID WASTE FACILITY PERMIT APPLICATION <br /> 54 C�n96 r-1-17 (NEW 6-71) <br /> CNI ORCt:MCNT AGENCY FOR ENFORCEMENT <br /> ' AGENCY USE ONLY — <br /> San Joaquin Local Health District �A FILE NUMBER (PERMIT NUMBER) <br /> �DVNrY <br /> i <br /> San Joaqu In '� DATE RECEIVED FILING FEE <br /> TYPE OF APPLICATION <br /> 2. APPLICATION 3- APPLICAttFt---- DATE ACCEPTED RECEIPT NUMBER <br /> OP ERAFTION *0 ---1 <br /> PAC LPER M * WASTE �J OF PERMIT pT® N FOR MODIFICATION <br /> -._---._ <br /> A. AMENDMENT DATE PER MtY 698UF_D CO SWMP REFERENCE PAGE S <br /> OF <br /> APPLICATION ❑ 9. APPLICATION FOR REVIEW <br /> (VOTE: This form has been developed for multiple uses. It is the transmittal sheet for documents required <br /> to be submitted to the enforcement agency. *A Report of Station or Disposal Site Information <br /> or an amendment thereto must be submitted with this form. <br /> NAME OF FACILITY <br /> — --- - - <br /> Escalon Wastewater Treatment Facilities <br /> LOCATION OF FA ClLi TY�GIYE ADDRESS OR LOCATION DEffiCRiPTION BY SECTION, TOWNSHIP• RANGE, COUNT Yr <br /> i River Road Sections 17 & 20, T2S, R9E, M.D. B & M <br /> TYPE OF FACILITY <br /> 6, <br /> SOLID WASTE DISPOSAL SITE STATION (INCLUDES RESOURCE RECOVERY) <br /> GENERA!_ <br /> ' TYPE OF WASTES TO BE RECEIVED <br /> DESCRIPTION <br /> 1 RESIDENTIAL REFUSE El CONSTRUCTION/DEMOLITION WASTES HAZARDOUS WASTES <br /> OF <br /> FACILITY a COMMERCIAL SOL1D WASTES SEWAGE SLUDGE Q AGRICULTURAL WASTES <br /> TIR EB LIQUIDS/SLURRIES 9EPT/C TANK PUMPINGS <br /> 1 <br /> x <br /> OTHER (SPECIFY'. P <br /> Street Sweepings <br /> _ns <br /> -.a <br /> 11. OPERATION t EF FE CTt_ Vff PROPOSED CHANGE (CHECK ONE OR BOYHj t 6FFECTWE _ <br /> t ACILITY 1 I DATE ( DATE <br /> INFORMATION M COMMENCED D WILL COMMENCE 1 D DESIGN D OPERATION 1 <br /> OWNER OF PROPERTYTNAME) 1 ADDRESS <br /> City of Escalon <br /> 111. ------- ------ <br /> �O►ERATOW�NAMET t ADDRESS <br /> OPERATOR l 1 <br /> I City of Escalon <br /> INFORMATION _- __-.. .. _._-- _..__. _. ___ _.._._. __ ... <br /> ADDRESS WHERE LEGAL NOTICE MAY BE SERVED <br /> P. 0. Box 248, Escalon, CA, 95320 <br /> IV. <br /> FILING FEE ENCLOSED <br /> .� f <br /> I hereby acknowledge that I have read this application and the Report of Station or Disposal Site Informa- <br /> tion, and certify that the information given is true and accurate to the best of my knowledge and belief. <br /> In operating the solid waste facility, I agree to comply with the conditions of the permit and with state <br /> and local enactments. <br /> SIGN U R OR SIGNATURE OPERATOR ON AGENT <br /> TYP M TYPED NAME <br /> Earl Wilson <br /> T/TLE TITLE <br /> City Administrator Aug,. 15, 19 <br /> -1-C;�ECK APPROPRIATE BOX <br /> ENFORCEMENT <br /> i APPLIGATtON APPROVED APPLICATION DENIED <br /> AGENCYi---..__-._—.___.__ -_____. ____...- _._ _._. _ .___. ..._-... ]­___.-._.. <br /> SIGNATURE TITLE AND PRINTED NAME D L E AND TELEPHONE NO. <br /> USE ONLY <br /> DATE RECEIVED CHECK APPROPRIATE BOX--'1 <br /> SOLID i Q CONCUR WITH OBJECT TO Q <br /> WASTE PROPOSED PERMIT PROPOSED PERMIT AGENCY DENIAL UPHELD <br /> � <br /> MANAGEMENT , <br /> BOARD <br /> SIGNATURE TITLE AND PRINTED NAME DATE AND TELEPHONE NO. <br /> USE ONLY <br /> I <br />