Laserfiche WebLink
'STATE OF CALIFORNIA <br /> REGIONAL WATER QUALITY CONTROL BOARD <br /> DEPARTMENT OF HEALTH SERVICES <br /> SOLID WASTE MANAGEMENT BOARD <br /> DEPARTMENT OF FORESTRY 1' <br /> / <br /> APPLICATION FOR <br /> FACILITY PERMIT/WASTE DISCHARGE <br /> This form is to be used for filing a/an: (check all appropriate) FOR OFFICE USE ONI.y <br /> 1. 1 REPORT OF WASTE DISCHARGE Form 200 Rec'd,u__`- <br /> Ipursuent to Division 7 of the State Water Code) Fee(RWOCB)_ -,__ (SWMBI.. <br /> 2. [ APPLICATION FOR A HAZARDOUS WASTE FACILITY PERMIT Letter to Discharger_w__ <br /> (pursuant to Health and Safety Code Section 25200) Report <br /> 3. C_ APPLICATION FOR A SOLID WASTE FACILITIES PERMIT Effective Date` — — <br /> Ipursuent to Government Code Section 66796.30) - <br /> 4. �—J APPLICATION FOR A RUBBISH DUMP PERMIT CDF Notified <br /> (pursuant to Public Resources Code Sections 4371-4375 and 4438) DOHS No. <br /> SWMB No.------ --- ---- -- <br /> 1. FACILITY <br /> A. NAME OF FACILITY T[L[PNON■1• <br /> B. NAME OP LEGAL OWNER OF FACILIT—Y -- <br /> 21. <br /> — EIP coo[ <br /> C. NAME OF alU91N e68 OPER ATINO FACILITY -_-----'---v--- Tt L6 PN Ont • ' <br /> ADOR[!• LIP COOL <br /> D. TYPE OF RU61Ne 96 OPERATING PACILI4Y ' <br /> ClSole Proprietorship Partnership ® Corporation Government Agency <br /> E. NAME OF OW NERr9rOF'RUSIN666 OPERATING FACILITY TRL6 PN ON[ • <br /> __ —..___._....-.— .—___._.--_. _ __ <br /> wOOR[!E WN[aH L[OAL NOTIC[MAT •[[[RV[D ZIP COWL <br /> 11, REASON FOR FILING <br /> CNRCR ALL APPROPRIATR: <br /> A. New discharge or facility D. Change in character of discharge G. Change in business operating facility <br /> 8, Existinq discharge or facility E. Change in place or method of disposal H. Enlargement of existing facility <br /> C. Increase in quantity of discharge F. Change in design or operation I. Other(explain below) <br /> III. TYPE OF OPERATION <br /> CN[QN ALL APPROPRIATE.: <br /> A. Transfer station D. Sewage treatment G. Woodwaste site <br /> R. Solid waste disposal site E. Industry(on-site disposal facility) H. Other(explain below). <br /> C. Hazardous waste disposal site F. Industry Idischarge to sewer) <br /> IV. TYPE OF WASTE <br /> CN[ea ALL APPROPRIAT[: <br /> ASewage,sewage sludge,and/or E. Agricultural wastes I. Inert materials <br /> septic tank pumpings <br /> B. Industrial wastes F. Animal wastes J. Dead animals <br /> C. Municipal solid wastes G. Forest product wastes K. Tires <br /> D. Hazardous wastes H. Construction/demolition wastes L. Other(explain below) <br /> V. SITE DESIGN CAPACITY --- — i--- — <br /> A,Pa[L[N♦POPULATION Oa CAPACITr R,DO VON POPULATION OR ULTIMAT[CAPACITY C.LIP[[x POCTANCv v[ARs <br /> FORM too(Rev.$/oo) (OVER) <br />