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STATE U.' CALIFOR141A SOLID WASTE MANAGEMENT BOARD <br /> SOLID WASTE FACILITY PERMIT APPLICATION <br /> SSWM9 E-1-77 (NEW 6-77) <br /> ENI'ORCC M[NT AGENCY <br /> FOR ENFORCEMENT AGENCY USE ONLY <br /> San. Joaquin Local Health District FILE NUMBER ►ERMIT NUMBER) <br /> San Joaquin OAT[ RECEIVED -- - FILING FEE - ---- <br /> TYPE OR APPLICATION 9-4- 77 <br /> 2. A►P LICATlONDATE AGCEFTEO RECEIPT NUMBER <br /> 1.OPERATCE OF F Oft 90ION • �� PPAC ER'MIT WASTE ❑ OAPPLICATION <br /> PERMIT T ICON FOR MODIFICATION --�--- <br /> 4.AMENDMENT - DATE PERMIT ISSUED CO SWM►REFERENCE PAGE • <br /> OF ------- -- --- ----APPLICATION El_-- S. APPLICATION FOR REVIEW --_---_- _- -__ ___ _._....-.-�-1y,•„�, <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 /> ---- --- --- --'- - ----_. . . - - -- . .- - - - ----- --- -- --------- -- --- <br /> NAME OF RACILivY <br /> __-- Foothill_ SanitaryLandfill _ --.---- --------'•-------____-- _-- <br /> LOCATION OF FACILITY rGiVE ADDRESS OR LOCATION DESCRIPTION BY SECTION,TOWNSHIP,RANGE, COUNTY <br /> Waverly Road, 640 acres in Sections 12 & 13 T2NR9E M.D.B. & M. <br /> 1, <br /> ® SOLID WASTE DISPOSAL SITE ❑ TRANSFER/PROCESSING STATION (INCLUDES RESOURCE RECOVERY) <br /> 6tNERAL ----.--- -----_..__ _--_'-- --_--- ..._ _.____..-...__ ___._.._ ....___..___—_------..._._—.--..___...__ _ — <br /> TYPE OF WASTES TO■E RECEIVED <br /> DESCRIPTION <br /> �1 RESIDENTIAL REFUSECONSTRUCTION/DEMOLITION WASTES HAZARDOUS WASTES <br /> OF <br /> FACILITY I © COMMERCIAL SOLID WASTES ❑ SEWAGE SLUDGE M AGRICULTURAL WASTES <br /> © TIRES ❑ LIQUIDS/SLURRIES Q SEPTIC TANK PUMPING& <br /> OTHER /ISPECIFY) __..-_ _____.. _,:,__.--�_.�..�_-,-_ ._;_._ <br /> arr <br /> _�.�..-.._...L___.-..._..._r_— -_ __ F- <br /> ____ _— -- - <br /> 11. OPERATION '^{ - 1 DATE CTIVt FROPOSEO CHANGE �6HECK ONE OR BOTNr I DATEzFrz <br /> INFORMATION © COMMENCED L�j WILL_COMMENCK 1 19FACILITY <br /> 65 ❑ DESIGN OPERATION ( <br /> OWNER OF PROPERTY NAMEr i ADDRESS Six South El Dorado Suite 0 <br /> Howard Lewis et al 1 Stockton, California 95202 <br /> 111, __._.---- <br /> OPER ATOR�NAMET^ 1 ADDRESS <br /> OPERATOR i <br /> INFORMATION Footh.illSanitary Landfill, Inc. ; (same as below) <br /> ADDRESS WHERE LEGAL NOTICE MAY BE SERVED <br /> P. 0. Box 1528 , Stockton, California 95201 <br /> L FILING FEE ENCLOSED - <br /> IV. <br /> f <br /> 1 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 knowiedge 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 /> SIGNAT WHEN OR A`GENT _- . SIONATU)PUL.(OPERATOR O,A"NT - --' <br /> TYPED NAME TYPED NAM[ <br /> Howard Lewis Dant J. Nomellini <br /> TITLE _DATE TITLE DATE <br /> Owner' s Representative /� 77 President <br /> . - -.. _ .- _ - .-! IF -- - - - ----._ _ -- - - —� <br /> CHECK APPROPRIATE BOX <br /> ENFORCEMENT) <br /> APPLICATION APPROVED APPLICATION DENIED <br /> AGENCY �------._-_--------- ------__._._._--.__.__._ __._........----- -- --._.._._._ _....,._. <br /> SIGNATURE TITLE AND PRINTED NAM[ DATE AND TELEPHONE NO. <br /> USC ONLY <br /> DATE RECEIVED LIE] <br /> CK APPROPRIATE BOX <br /> SOLID 1 CONCUR WITH OBJECT TO ❑ <br /> 1 PROPOSED PERMIT PROPOSED PERMIT AGENCY DENIAL UPHELD <br /> WASTE MANAGEMENT OTHER SPECaryBOARD <br /> -----�---------. <br /> &IGNATURE TITLE AND PRINTED NAME DATE AND TELEPHONE NO. <br /> 01 <br /> US[ONLY <br />