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STATE OF CALIFfORNIA <br />CALIFORNIA INTEGRATED WASTE MANAGEMENT HOARD ( I <br />REGIONAL WATER QUALITY CONTROL BOARD <br />APPLICATION FOR SOLID WASTE FACILITY PERMITIWASTE DISCHARGE REQUIREMENTS <br />CIWMa E-1-77 (Rev. a -N1 <br />NOTE: This form has been developed for multiple uses. It is the transmittal sheet for documents required to be submitted to the appropriate agency. <br />Please refer to the attached Instructions for definitions Of terms and for Completing this application form n I <br />a Complete <br />and correct manner. <br />FOR OFFICIAL USE ONLY <br />SWIS NUMBER: <br />FILING FEE: <br />RECEIPT NUMBER: DATE RECEIVED: <br />DATE ACCEPTED: <br />DATE REJECTED: <br />ACCEPTANCE DATE OF <br />INCOMPLETE <br />APPLICATION: <br />DATE DUE: <br />Part 1. GENERAL INFORMATION <br />A ENFORCEMENTAGENCY: B. COUNTY: <br />County o'S <br />San Joaquin, Environmental Health Department San Joaquin <br />C. TYPE OF APPLICATION (Ch k b ly). <br />El 1. NEW SWFP and/or WDRS ❑4. PERMIT REVIEW <br />2. REVISION OF SWFP and/or WDRS ❑5. AMENDMENT OF APPLICATION <br />❑3. EXEMPTION antl/or WAIVER XQ6. RFI/ROWD/JTD AMENDMENTS <br />Part 2, FACILITY DESCRIPTION <br />OF FACILITY: <br />f•'?i <br />30703 S. Macarthur Drive, Tracy, CA 95376 <br />2. LATITUDE AND LONGITUDE: <br />Lat 37.67803 North, Long -121.41618 West <br />3. LEGAL DESCRIPTION OF PERMITTED BOUNDARY BV SECTION, TOWNSHIP, RANGE, BASE, AND MERIDIAN, IF SURVEYED: <br />C. TYPE OF ACTIVITY: (Check applicable boxes): <br />�1. DISPOSAL O3. TRANSFORMATION U6. OTHER(descdbe): Cannery Waste <br />a. TYPE: <br />3q2. COMPOSTING O4. TRANSFER/PROCESSING FACILITY <br />a. TYPE: Green Waste X CHECK HERE IF RECYCLABLE MATERIALS ARE RECOVERED PRIOR TO TRANSFER/PROCESSING. <br />D. CONFORMANCE FINDING INFORMATION (CIWMP): <br />01. FACILITY IS IDENTIFIED IN (Check one): <br />SITING ELEMENT DATE OF DOCUMENT Mar -97 PAGE# <br />�NONDISPOSAL FACILITV EL DATE OF DOCUMENT PAGE # <br />F12. 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 />1. AGRICULTURAL <br />F-12, <br />ASBESTOS O Friable ❑Non -Mable <br />F13. ASH <br />F14, AUTO SHREDDER <br />IX 15. COMPOSTAeLE MATERIAL (describe): <br />O6. CONSTRUCTION/DEMOLITION <br />O7. CONTAMINATED SOILS 0 <br />D8. DEAD ANIMALS <br />XDo, INDUSTRIAL <br />10. INERT <br />Green Waste <br />�11. uuulbs <br />12. MU(ED/MUNICIPAL SOLID WASTE <br />13. SEWAGE SLUDGE <br />014, <br />TIRES <br />X❑ 15. OTHER (describe): Appliances, u -waste, a -waste <br />Page 1 <br />