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-WPLICATIOIN F()R
<br />0PER-m%cvLpPA l
<br />FOR FAMITIES (t1CW-1ING HAZAII L)O Us WASTE
<br />R)Ccun-Zn"t i)
<br />---- — ------
<br />&)P'lC1'tiL)n for:
<br />r (1) Facility Permit Nurnber (2)
<br />1 10 Operating Permit
<br />r
<br />-odification of Pernnit
<br />—
<br />Change in L)vsign b 000 /�7B
<br />2 L- MOats
<br />EJ Change in Operation
<br />Chonge in Ownership/ Cime Permit Issued
<br />Operator
<br />Name and Street A,ldrcss of Facility
<br />(5)
<br />Austin Road Class H-.]. Disposal Sit("
<br />Austin Road (I4�5 t Side.) 2, 5 mi le s/o I. S.
<br />MariposT, Road and AUSt in Road
<br />Son Joaquin County, California
<br />N10111c and 11z,illng Addr(.,ss.of Legal Owner of Facility (7)
<br />f'orw�,.rd, Inc_
<br />f' -O, Box 6336
<br />StUCkiC'1, CA 9r; 0
<br />Tr'.ephonc ( 2!,*.._j) 4)r I
<br />66-519?
<br />Ty,r,c
<br />of Facility (Check all arjora pt lato
<br />Lw-,dfill
<br />❑So
<br />r a g c,
<br />P ("; I d
<br />c.7
<br />CC) ry I po " t i 1) g
<br />riCsOurce Recovery
<br />❑
<br />lrijec(ion Well
<br />Trollsfe! Stalk),
<br />- 'I❑
<br />Other
<br />F
<br />14310 Of U'Oi;orni,s
<br />of
<br />County Assessor's Parcel Nt. mt)e,
<br />Boo k, C-19, j
<br />yc
<br />Zone EA -10
<br />G^Ographic,j L,iiioit of Pj(j:jt,1, (4)
<br />Swction —3-
<br />Railop IT—
<br />OPERATOR
<br />Nanne and Address cf
<br />Or�?,-,,Tinq Facility
<br />Forward, Inc.
<br />P.C. Box 6336
<br />Stockton, CA 95206
<br />Tefenhone 205 4 66 - 5 192
<br />Type of Ruiness Facility
<br />Sole Proprictoislill) C-1 C o r p o r, o, i
<br />D Partnership novcrtim.ont i%q,,ncy
<br />Name and Address o' OvI. cj (5) of H L isi r, r. -Fs 0 1) �. r,
<br />�
<br />(Mmt be address vilicre notice may be s,,nv�!oj .1 -tc iity
<br />Greqory Basso/1-rank
<br />401 S. Lincoln Strcet
<br />Stockton, CA 95206
<br />r -I
<br />00 of Ztk!i s;(U`ved (Check ,:l
<br />and/or consult Sec. G1021131 & 60.),M), riltv 22, Calii. Adm.
<br />Codc, for additional names of hazardc)u.-, w;:jstv.s.)
<br />Acid solution solvent
<br />Ll Alkaline solution ❑ Tetraethyl ;ea(i si,,rfye is Driliino inui
<br />EJ Pwicides ❑ Chernicat toilvj v,3s,
<br />es
<br />a nt slu(,,gL! U Tan1x-bottom S0J7rr,ent soil ruts s,,rd
<br />other: Pesticide. 1-!a
<br />Dt,,es the Public 11%, facility ? yes r i i m arid S t ror, t
<br />r Wc� t r,
<br />)0l'L Of Disposal sit", Jr1for-m-itiolil
<br />Atti ,`It )v( -i the Facility.
<br />list of requiatory 3qPficies h,,vinq jurisdiction numh�rs whe, r approp, iat-�,
<br />Include any pe
<br />rmit
<br />1'r!fC'l-)Y "ellifY that I I hO illfci-Inzition wovidud in this C:pplicatiorl and ill the at-,achments (lisled holovy) is true arid accur,n,, to Il.e
<br />bt-'St Of my knovtj;),JT*
<br />. Attzchr 1F nts:
<br />(13) S, ure of Operator fi f}
<br />G;- C j 0 1 Y J,
<br />Oa to Vice Presic!cniL Tit!e Ci i e jj
<br />Vice Presidcnt
<br />f R,
<br />;"-I t -ii -07 (*la -r T
<br />CALI FO.-it,11i), DI �Ali I t 'NT C A I
<br />I ri�ltcld cr I -jpc,,,' NwTj(-
<br />LrinYed 0-- I'Ypi'd Naf-.-.(,,
<br />"ale
<br />.1tit 7 7)
<br />
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