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V, <br /> 6 { ' <br /> .t SOLID wASIC VANAC-FME'NT BOARD <br /> STAR �F Cia LIFGRIJIA <br /> SfJ' -loO WASTE FACILITY PERMIT APPLICA At'ib <br /> Ss1"M1IA r-1-17 NrW 6-71 j „, 1 `'•i <br /> r.Nl ORCI:MENT AGENCYR <br /> � 5 5�'� ENFORCEMENT AGENCY USE ONLY <br /> San Joaquin County_Local Health District r.I f ,�c. I } 4P UMBER (PERMIT NUMBER) <br /> San Joaquin i- --- — — - -FILING -- <br /> DA.T"E RECEIVED \ NG FEE <br /> TYPE OF APPLICATION <br /> 2. APPLICATION !!l--- 3. OAT---E ACCEPTED RECEIPT NUMBER _ <br /> X OPI. NOTERAITION • PFAC L ER MI�tr WASTE ! ' OF PERAPPLT N FOR MODIFICATIOF{ <br /> A, AMENOMENT gH PERMIT ISSUED CO SWMP REFERENCE PAGE $ <br /> OF <br /> APPLICATION Q S. APPLICATION FOR REVIEW <br /> NOTE: 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 /> City of Tracy -San Joaquin County Landfill <br /> LO CA710N OF FACILITY [GIVE ADDRESS OR LOCATION DESCRIPTION BY SECTION, TOW NSH i P, RANGE, COUNTY <br /> Corral Hollow Road - I-580 <br /> L <br /> PE 4F FACILITY <br /> 1. <br /> SOLID WASTE DISPOSAL SITE a TRANSFER/PROCESSING STATION (INCLUDES RESOURCE RECOVERY) <br /> GENERAL ----------------—- --------- -------------..__.___.____----._..__.. _-'-_.._ _- --- ---- - ...- --'----------- -- --- . __._------------- <br /> TYPE OF WASTES TO BE RECEIVED <br /> DESCRIPTION <br /> 1 RESIDENTIAL REFUSE ® CONSTRUCTION/DEMOLITION WASTES HA.AR..U. WASTES <br /> OF <br /> FACILITY � COMMERCIAL SOLID WASTES ''' SEWAGE SLUDGE u AGRICULTURAL WASTES <br /> DTIRES A, LIQUIDS/SLURRIES ( ! SEPTIC TANK PUMPING. <br /> L.j' OTHER (SPE CHFY9 - _ <br /> A1. OPERATION 1 EFFECTIVE PROPOSED CHANGE (CHECK ONE OR BOTHJ I &FFECTIVE <br /> F ACt LITY ' (� a I DAT 1 DATE <br /> INFORMATION L� COMMENCED WItL COMMENCE 0 DESIGN OPERATION I <br /> OWNER OF PROPERTY [-NAME 1 ADDRESS <br /> I City of Tracy-San Joaquin County ; P.O. Box 1029, Tracy <br /> III. --- <br /> C PER AT®R TNA MEI_____ I ADDRESS <br /> OPERATOR ? t <br /> INFORMATION ° ---City of Tracy,-- <br /> ADDRESS <br /> racy -ADDRESS WHERE LEGAL NOTICE MAY BE SERVED - <br /> 325 E. 10th Street <br /> FILING FEE ENCLOSED <br /> IV, <br /> $ - -n/a <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 /> NT GNATU IOP ATOR OR AGENT <br /> \._ <br /> TYPED . AME TYPE "NAME <br /> ----Rober-t__C __Schn:ei:derRobert_C._--5_chneder_----- -- <br /> TITLE ®AT6- ----- TITLE -f DATE' <br /> Public-,_Works Director -_ _. _ .� 8/12/77 Public- WorksDirector_ __�8/12�77 <br /> CHECK APPROPRIATE BOX <br /> ENFORCEMENT <br /> I APPLICATION APPROVED APPLICATION DENIED <br /> AGENCY I-.-- <br /> SIGNATURE TITLE AND PRINTED NAME DATE AND TELEPHONE NO. <br /> USE ONLY 1 <br /> ---_-- GATE RECEIVED CHECK APPROPRIATE SOX <br /> SOLID CONCUR IOBJECT TO <br /> WASTE PROPOSED PHERMIT PROPOSED PERMIT AGENCY DENIAL UPHELD <br /> MANAGEMENT <br /> BOARD _ _ OTHER [SPECIFY)___ <br /> rSaaNAT URG TITLE AND PRINTED NAME DATE AND TELEPHONE NO. <br /> USE csNLY I <br />