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Fr'' 1, <br />STATE OF GALIFORNIA <br />CALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD 2% <br />REGIONAL WATER QUALITY CONTROL BOARD 20 03, plP <br />APPLICATION FOR SOLID WASTE FACILITY PERMIT/WASTE DISCHARGE REQUIREMENTS <br />CIWMB_E-1-77_(Rev. 8-04)�I\I,iih•i!?J`'v{V1 ;1! (1l_ALT i <br />NOTE: This form has been developed for multiple uses. It is the transmittal sheet for documents required to be submitted to th fto6 i)ii <br />Please refer to the attached instructions for definitions of terms and for completing this application form in a complete and correct manner. <br />FOR OFFICIAL USE ONLY <br />SWIS NUMBER: <br />FILING FEE: <br />RECEIPT NUMBER: <br />DATE RECEIVED: <br />39 -AA -002 <br />DATE ACCEPTED: <br />DATE REJECTED: <br />ACCEPTANCE DATE OF <br />INCOMPLETE <br />APPLICATION: <br />DATE DUE: <br />Part 1. GENERAL INFORMATION <br />A. ENFORCEMENT AGENCY: B. COUNTY: <br />ENVIRONMENTAL HEALTH DEPARTMENT SAN JOAQUIN COUNTY <br />C. TYPE OF APPLICATION (Check one box only): <br />1. NEW SWFP and/or WDRS ®4. PERMIT REVIEW <br />02. REVISION OF SWFP and/or WDRS 5. AMENDMENT OF APPLICATION <br />113. EXEMPTION and/or WAIVER 116. RFI/ROWD/JTD AMENDMENTS <br />Part 2. FACILITY DESCRIPTION <br />A. NAME OF FACILITY: <br />North County Landfill <br />B. LOCATION OF FACILITY: <br />1. PHYSICAL ADDRESS OR LOCATION AND ZIP CODE: <br />17900 East Harney Lane, Lodi Ca 95240 <br />2. LATITUDE AND LONGITUDE: <br />Latiitude:38 Degrees, 06 Minutes Longitude:121 degrees, 04 minutes <br />3. LEGAL DESCRIPTION OF PERMITTED BOUNDARY BY SECTION, TOWNSHIP, RANGE, BASE, AND MERIDIAN, IF SURVEYED: <br />APN 065-120-02, 065-120-03, 065-120-08, and 065-120-09 in Section 21, T3N, R8E, MDB&M <br />C. TYPE OF ACTIVITY: (Check applicable boxes): <br />X❑1. DISPOSAL E-13. TRANSFORMATION r-15. OTHER (describe): <br />a. TYPE: Class III <br />72. COMPOSTING 04. TRANSFER/PROCESSING FACILITY <br />a. TYPE: ❑ CHECK HERE IF RECYCLABLE MATERIALS ARE RECOVERED PRIOR TO TRANSFER/PROCESSING. <br />D. CONFORMANCE FINDING INFORMATION (CIWMP): <br />1. FACILITY IS IDENTIFIED IN (Check one): <br />SITING ELEMENT <br />EDNONDISPOSAL FACILITY EL <br />DATE OF DOCUMENT Apr -96 <br />DATE OF DOCUMENT <br />-12. FACILITY IS NOT REQUIRED TO BE IDENTIFIED IN SITING ELEMENT OR NONDISPOSAL FACILITY ELEMENT <br />E. TYPE OF PERMITTED WASTES TO BE RECEIVED: (Check applicable boxes): <br />71. AGRICULTURAL x❑6. CONSTRUCTION/DEMOLITION F-111. LIQUIDS <br />72. ASBESTOS ❑ Friable ❑ Non -friable <br />73. ASH <br />74. AUTO SHREDDER <br />F--17. CONTAMINATED SOILS <br />1--18. DEAD ANIMALS <br />x❑9. INDUSTRIAL <br />E-110. INERT <br />FLI12. MIXED/MUNICIPAL SOLID WASTE <br />❑ 13. SEWAGE SLUDGE <br />El14. TIRES <br />xj 15. OTHER (describe): <br />Household hazardous waste <br />PAGE# 18 <br />PAGE # <br />X75. COMPOSTABLE MATERIAL (describe): Green Wood waste, Yard Clippings <br />Page <br />