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` 9TAYE OF CALIFORNIA REGIONAL,WATER QUALITY CONTROL BOARD DEPARTMENT OF HEALTH SERVICES SOLID WASTE MANAGEMENT BOARD DEPARTMENT OF FORESTRY INSTRUCTIONS FOR COMPLETING APPLICATION FOR FACILITY PERMIT/WASTE DISCHARGE This application form is for'a permit (and/or waste discharge requirements) to discharge, receive, or dispose of liquid or solid wastes regulated by the California Regional Water Quality Control Boards (RWQCB), the Department of Health Services (DOHS), the State Solid Waste Management Board (SWMB), or the California Department of Forestry (CDF). This form and the filing fee' should be sent to the appropriate agency(s) as indicated below: FORM USE APPROPRIATE AGENCY RWQCB DOHS SWMBZ CDF3 Report of Waste Discharge . . . . . . . . . . . . . . . . . . . . . . . . . . X Application for a Hazardous Waste Facility Permit. . . . . . . . . . . . . . . . . . . . . X Application for a Solid Waste Facilities Permit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X Application for a Rubbish Dump Permit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X If you have any questions on the completion of this form, please contact the appropriate agency for assistance. For a direct discharge (point source discharge) to surface waters, a different application form is required in place of this Form 200. Please contact the appropriate Regional Water Quality Control Board for a National Pollutant 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 informa- tion will be required, and should be submitted on 8%:" x 11" paper. Complete the enclosed form and return it with any required report'-'and the filing fee to each appropriate agency(s). The agency(s) will advise you of any additional 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 RWQCB Use flow or units reported In Item VI (Form WRCB 200)and the appropriate class schedule A,B,B1,62, B3,or C(attached Filing Fee Schedule). Make check payable to: STATE WATE R RESOURCES CONTROL BOARD and mail, together with report of waste discharge,to the appropriate Regional Board.No report can be accepted without the fee. SWMB Local solid waste enforcement agencies shall determine the exact fee. The maximum application fee that can be required is five hundred dollars ($500). DOHS and CDF No fee is required. 2Check with local or county enforcement agency for specific permit requirements and/or exemptions. "If the site is within an incorporated city or on federal land,a copy need not be sent to CDF. 4REQUIRED REPORT FOR DOHS: An Operation Plan. 'REQUIRED REPORT FOR SWMB: 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 operatingday). Where there is a significant change in design, operation,operator, or size of facility,details of the changes must be submitted to amend previous report. See attachments for information to be contained in reports.