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State of California • Department of Resources Recycling and Recovery (CalRecycle) CalRecycle Standardized Permit Application CalRecycle 92 (Revised 10/16) See instructions on back FacilityName: fie ?fY Bomb Ln�1��5 Facility phone number: .(zoq ) 6%cq,G/ %S—C( Facility Address (include street, P.O. box, city, state, ZIP code): /6SS I ffer~r� 9b 9s azo Facility Operator's Name: 6�7Conz i pu4le.d6 Operator's phone number: ( ) Operator's Address (include street, P.O. box, city, state, ZIP code): tle?4 SAWXel(o oaf (e Cgtf (� an Owner's Name (if different from operator): jYlArlGte) V4Si (✓ci, Land Owner's phone number: ( ) Land Owner's Address (include street, P.O. box, city, state, ZIP code): /$/73 Sfe,'negu f Ra Esoa7on c4 9�z& Facility Information California Code of Regulations section number authorizing eligibility: Type of waste material(s) handled (please be specific): Volume of waste material(s) handled. Site Capacity: 5,000 Cubic yards I Daily peak loading: 7JZ✓WCubicyards Annual loading: Cubic yards Days and hours of operation: 7:�0 Facilitysize:CJU y44W acres I Operating area size: acres Incoming waste material (number of vehicles per day): fo Outgoing waste material (number of vehicles per day): 5 One of the following statements must be checked: Issuance of the permit will not prevent or substantially impair achievement of the diversion goals of the jurisdiction from which it received solid waste; the facility is identified and described in or conforms with the county solid management waste plan, or otherwise complies with Public Resources Code 50000; The facility is consistent with the city or county general plan and is compatible with surrounding land uses, or otherwise complies with Public Resources Code 50000.1. ❑ The facility is identified in either the countywide siting element, the nondisposal facility element, or in the source reduction and recycling element for the jurisdictions in which it is located; or, that the facility is not required to be identified in any of these elements pursuant to section 50001 of the public resources code. This application must be accompanied by a: ❑Report of facility information, ❑ Evidence of compliance with CEQA, or F-1Certification ❑ Site plan, ❑Location map, and either Information on the status of CEQA I hereby local requirements and enactments. / Landowner's signature: � �I J acknowledge that I have read this application, and certify under penalty of perjury that the information provided is true and accurate. In operating the facility, I agree to comply with the conditions of the permit, and with federal, state and ,p)itq,L>;/�- Operator's signature: 6e..v rq C Enforcement Agency Name and Address: For Enforcement Agency Use Only Date Received: Date Approved: Date Rejected: Date signed; �^zs'L � Date signed: 0 — Z S � < Filing Fee: SWIS #: