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.STATE OF CALIFORNIA <br /> DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY <br /> REGIONAL WATER QUALITY CONTROL BOARD <br /> APPLICATION FOR SOLID WASTE FACILITY PERMIT AND WASTE DISCHARGE REQUIREMENTS <br /> CALRECYCLE E-1-77(R...11-15) <br /> NOTE:This form hes been developed for­t"'. uses. It Is the[renamlttal sheet for documents requlred to be submitted to the eppr,prlete agency. <br /> Please refer t the a ch,d Inetructlo ns for deflnitlone of[arms end forCompleting this application form In a mplete end c <br /> FOR OFFICIAL USE ONLY <br /> ISM/DID/Gl.nel ID NUMBER: FILING FEE: RECEIPT NUMBER: DATE RECEIVED: <br /> DATE ACCEPTED: DATE REJECTED: ACCEPTANCE DATE OF <br /> INCOMPLETE APPLICATION: <br /> DATE DUE: <br /> Part 1.GENERAL INFORMATION <br /> A.ENFORCEMENT AGENCY: B.COUNTY: <br /> C.TYPE OF APPLICATION(Cheep ane-1.11y): <br /> FT NEW SWFP.nd/n.WDRS 4.PERMIT REVIEW <br /> 2. CHANGE TO SWFP.hd/er W DRS 5.AMENDMENT OF APPLICATION <br /> ❑REVISION ❑MODIFICATION ❑OTHER(A..uth.rlt.d by I-) <br /> 1:13. WAIVER 6.RFI/ROWD/JTDAMENDMENTS <br /> Part 2. FACILITY DESCRIPTION <br /> A. NAME OF FACILITY: <br /> B. LOCATION OF FACILITY: <br /> 1. PHYSICAL ADDRESS OR LOCATION AND ZIP CODE: <br /> 2. LATITUDE AND LONGITUDE: <br /> 3, LEGAL DESCRIPTION OF PERMITTED BOUNDARY BY SECTION,TOWNSHIP,RANGE,BASE,AND MERIDIAN,IF SURVEYED: <br /> C.TYPE OF ACTIVITY:(Ch..k applicable b...a): <br /> 1.DISPOSAL F-1 3.TRANSFORMATION 5.C&D/INERT DEBRIS PROCESSING <br /> .. TYPE: <br /> 2.COMPOSTABLE MATERIALS HANDLING M 4.TRANSFER/PROCESSING 6.IN-VESSEL DIGESTION <br /> e. TYPE: <br /> ❑ 7.OTHER(........): <br /> D.IDENTIFICATION OF FACILITY IN CIWMP[CONFORMANCE FINDING]: <br /> 1.FACILITY IS IDENTIFIED IN(C....eh.): <br /> SITING ELEMENT DATE OF DOCUMENT PAGE# <br /> NONDISPOSAL FACILITY ELEMENT DATE OF DOCUMENT PAGE# <br /> E.TYPE OF PERMITTED WASTES TO BE RECEIVED:(Cheek applleabla b....): <br /> M 1.AGRICULTURAL 0 6.CONSTRUCTION/DEMOLITION M 11.LIQUIDS <br /> ❑ 2.ASBESTOS Frl.bl. N.--.- r__j 7.CONTAMINATED SOILS ❑ 12.MUNICIPAL SOLID WASTE(MSW) <br /> 71 3.ASH 0 8.DEAD ANIMALS 13.SEWAGE SLUDGE <br /> M 4.AUTO SHREDDER 0 9.INDUSTRIAL 14.WASTE TIRES <br /> 10.INERT El 15.OTHER <br /> 5.COMPOSTABLE MATERIAL(d..erlb.): <br /> Page 1 <br />