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This application form is for a Solid Waste Facilities Permit and /or waste discharge requirements to receive, store, process, transform, or dispose of solid waste regulated by the California Integrated Waste Management Board (CIWMB) and the California Regional Water Quality Control Boards (RWQCB). This form and the filing fee should be sent to the appropriate agency(s) as indicated below: FORM USE APPROPRIATE AGENCY CIVM RWCICB Application for a Solid Waste Facilities Permit X Report of Waste Discharge / WDRs X If you have any questions on the completion of this form, please contact the appropriate agency for assistance. For direct discharge (point source discharge) to surface waters, a different application form is required in place of this Form. Please contact the appropriate RWQCB for a National Discharge Elimination System (NPDES) application form to apply for a permit for this type of discharge. This application for waste disposal provides initial notice of a waste discharge. In most instances, additional information will be required, and should be submitted on 81/2"X 11" paper. Complete this form and return it with two copies of any required report and the filing fee to each appropriate agency(s). The agency(s) will advise you of any addition information that may be required to complete this application and waste disposal report. The effective date of the application is the date when all required information and the correct fee are received by the agency(s). You will be notified of this effective date by each agency. AMOUNT OF FILING FEES CIAMB RVVQCB The enforcement agencies shall determine the exact fee. Use flow or units reported in item III (application form) and the appropriate class schedule A, B, B1, B3, or C (attached filing fee schedule). Check with local or county enforcement agency for specific permit requirements and/or exemptions. V 9WVeP •-•9• •- A"Report of Disposal Site Information" is required to obtain a permit to operate a disposal site. A "Report of Station Information" is required to obtain a permit to operate a large volume transfer station (greater than 100 cubic yards per operating day). A "plan of Operation" is required to obtain a permit to operate a small volume transfer station (less than 100 cubic yards per operating day). A "Report of Composting Site Information" is required to obtain a permit to operate a composting operation. Where there is a significant change in design, operation, operator, or size of facility, details of the changes must be submitted to amend previous reports. No instructions will be listed for items that are self-explanatory. I. GENERAL DESCRIPTION OF FACILITY B. Location of Facility: Map or sketch should be to a scale adequate to show location precisely, Use of a portion of a U.S.G.S. Quadrangle map is recommended. Map must show proximity of disposal location to populated areas and must indicate all wells and drainage courses within 1,000 feet of any disposal point. C. Type of operation: Sewage treatment applies to a sewage treatment facility D. Type of waste to be received: