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STATE OF CALIFORNIA SOLIo WASTE MANAGEMENT BOARD <br /> SOLID WASTE FACILITY PERMIT APPLICATION <br /> SSWM■S-1-77 (NEW 9-77) <br /> ENFORCEMENT AGENCY FOR ENFORCEMENT AGENCY USE ONLY <br /> San Joaquin Local Health District FILE NUMBER PERMIT NUMBER <br /> couNrr —�'— <br /> San Joaquin County DAYS C[IV D FILING FEE <br /> TYPE OF APPLICATION-----__- --- - --- f'D <br /> -77 <br /> 2.APPLIIK OF FOR lCATION DAT ACCRPTEO RECEIPT NUMBER <br /> 1.a OPERATION • a FACILITYFHASTE D OF PERMIS. APPLICATION FOR MODIFICATION <br /> I.AMENDMENT DATE PERMIT ISSUED CO OWMF REFERENCE PAGE(S) <br /> OF - <br /> 1lRMI APPL/CATION D 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 /> Harney Lane Sanitary Landfill ____ _ <br /> LOCATION OF FACILITY GIVE ADDRESS OR LOCATION DESCRIPTION RY SECTION,TOWNSHIP,RANG[, COUNTYV <br /> On Harney Lane 1/4 mile east of Jack Tone Road, Seca 19, T. 3 N. , R. 8 E. , M.D.B.&M. <br /> TYPE OP FACILITY <br /> 1. <br /> aSOLID WASTE DISPOSAL SITE Q TRANSFER/PROCESSING STATION JINCLUDES RESOURCE RECOVERY) <br /> GENERAL TYPE OF WASTES TO BE RECEIVED - "- <br /> DESCRIPTION <br /> IQ RESIDENTIAL REFUSE ® CONSTRUCTION/DEMOLITION WASTES a HAZARDOUS WASTES <br /> OF <br /> 1 <br /> FACILITY D COMMERCIAL SOLID WASTES �a7 SEWAGE SLUDGE ^Q AGRICULTURAL WASTES <br /> DTIRES 1 V LIQUIDS/SLURRIES SEPTIC TANK PUMP#H08 <br /> -_ OTHAJ <br /> ER (SPECIFY) _„ <br /> s__-...._-_s__ _ <br /> 11 A OPERATION DATt SIVE PROPOSED CHANGE CH[CK ONE-0R BOTH ( [FFECTIVIE <br /> FACILITY V I i DATE <br /> INFORMATION X COMMENCED D WILL COMMENCE 1 1-1-75 D D[St ON D OPERATIONI <br /> OWNER of PROPERTY NAME - -- - 1 ADDRESS 221 W. Pine Street, Lodi, Ca. 95240 <br /> III City of Lodi--County of San Joaquin i P.O. Box 1810, Stockton, Ca. 95201 <br /> OPERATOR NAME � ADORES! <br /> OPERATOR CountyDe-ppartment of Public Works ; P.O. Box 1810, Stockton, Ca. 95201 <br /> INFORMATION <br /> ADDRESS WHERE LEGAL NOTICE MAY■E SERVED <br /> 1810_E. Hazelton Avenue, Stockton, CA 95205 <br /> -- _ FILING FEE ENCLOSED <br /> IV. <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 /> we TUR�O- SERO T) R_ S1QNA URE 1 [RATOR ORA Y <br /> .r , J ►, _ <br /> YPED HA �- - TYPED N ME <br /> Hen y A. Glaves, - C. E. Dixon W. Cypher <br /> TITLE DATE TITLE __j'OAT[ <br /> City Manager - County Administr _ � a ?— Maintenance Superintendent a <br /> ator } <br /> - - <br /> CHECK APPROPRIATE BOX <br /> ENFORCEMENT - <br /> AGENCY APPLICATION APPROVED -_--_ 1 1 APPLICATION DENIED <br /> SIGNATURE �- TITLE AND <br /> USE ONLY PRINTED NAME DATE AND TELEPHONE NO. <br /> DAT[ RECEIVED CHECK APPROPRIATE NdX - <br /> SOLID OBJECT TO <br /> .D MRO O.n.WITH <br /> D PROPOSED PERMIT <br /> WASTE AGENCY DENIAL UPHELD <br /> MANAGEMENT <br /> BOARDUSE ONLY <br /> SIGNATURE TITLE AND PRINTED NAM[ DATE AND TELEPHONE NO. <br />