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I '.iTATE OF CALIFORNIA <br /> REGIONAL WATER QUALITY CONTROL BOARD <br /> DEPARTMENT OF HEALTH SERVICES <br /> SOLID WASTE MANAGEMENT BOARD a <br /> 1 DEPARTMRNT OF FORESTRY <br /> APPLICATION FOR <br /> FACILITY PERMIT/WASTE DISCHARGE <br /> This forin is to be used for filing a/an: (check all appropriate) F'OR OFFICE USE ONLY <br /> Form 200 Roca___--- . _. - - - - <br /> 1. REPORT OF WASTE DISCHARGE Foe IRWOCEI) — (SWMB)__ <br /> (pursuant to Division 7 of the State Water Code) <br /> 2. � I APPLICATION FOR A HAZARDOUS WASTE FACILITY PERMIT Letter to Discharger <br /> (pursuant to Health and Safety Code Section 252001 Report Recd -- <br /> 3. l APPLICATION FOR A SOLID WASTE FACILITIES PERMIT Effective Data <br /> (pursuant to Government Code Section 66796.301 CDF Notified <br /> 4. APPLICATION FOR A RUBBISH DUMP PERMIT DOHS No. <br /> (pursuant to Public Resources Code Sections 4371-4375 and 4438) <br /> SWMB No. - <br /> -'--- - -- 1, rACILITY <br /> _72'O <br /> {L{.NON{ • <br /> A. NAM[ Or FACILITY <br /> TERRA GENESIS MANTECA SITE ( 209 521=6260_-__ <br /> ATTN: RICHARD BREW P_.0_._BOX_3212 MODESTO. CA 95353 -- <br /> -� - — <br /> T <br /> al{PMON{ • <br /> ■, NAM[OF LK*AL owii[w o�rACIL17Y <br /> TERRA GENESIS, _INS,___... {209 521-626Q----- <br /> _ - ------ - - -- ,1.cee. <br /> AeeR... r <br /> - .-R1C1iARD__BREW-_P.O___BOX.3212—MODESTO,-CA_95353-------- -- -- ----- <br /> C NwM[or joVOIN[a{ oPKN^TINO FACILITY <br /> 209 1. 521-6260 <br /> _TERRA-XI MES-IST INC_------ - - - - <br /> weeR{.. <br /> ATTN: RICHARD BREW P.O. BOX 3212 MODESTO, CA 95353 -- <br /> D •U■INS aa OPER ATINO /AGILITY <br /> �y� Corporation L� Government Agency <br /> Partnership Sole Proprietorship � P — —'� <br /> _ ___ — TaL{ weN{ • <br /> K. NAM[ Or O,rN[R ! Or [Ua1N[as O►[R WAY FACT LtYY <br /> TERRA GENESIS,_ INC_. 209..)-_521-6260--_ . <br /> AOOw■\. •N{w{L{YAL wOT1t{ Mw• •{ 1{w V{O <br /> RICHARD BREW P.O. <br /> -- - 11. REASON FOR FILING <br /> CN{CR ALL APPROPRIAT{: <br /> A. New discharge or facility D. Change in character of discharge G. _ Change in business operating facility <br /> B. Existing discharge or facility E. Change In place or method of disposal H. Enlargement of existing facility <br /> C. Increase in quantity of discharge <br /> F. Change in design or operation 1. X Other(explain below) <br /> Industrial prDcessor.-Df .soilcontaminated bXi1_de i ate -wa�tP_ _—__-_----- <br /> 9n -- < -- - __ - <br /> :_-_ ---_111. TYPE Or OPcn ATION <br /> CN{CN ALL APPAovw1wr{i <br /> A. <br /> p. Sewage treatment G JX� <br /> Woodwnste site <br /> B. Solid waste disposal site Transfer station E. Industry Ion-site disposal facility) N. Othor lexpisin below) <br /> _ <br /> C. Hazardous waste disposal site F. Industry (discharge to sower) <br /> Soil will be hauled to the site cleaned and PH at `a-n--J <br /> ===��pix�v�d�`rtp�or-fi`rfifi—and�opsQrl;v. T�:!ov wwere <br /> ­c. ALL wPPwOPwlw r{ <br /> A Sewage,sewage sludge,and/or E. Agricultural wastes I. - Inert materials <br /> septic tank pumpings J. Dead animals <br /> B. Industrial wastes F. Animal wastes _ <br /> C. Municipal solid wastes G. Forest product wastes K. - Tires <br /> D. Hazardous wastes H. Construction/demolition wastes L. Other (explain below) <br /> Ther_.ei1-Lhe-no-di-wh rae-of designated-waste -at site or-other-locatipiL.-_--:-__ <br /> - ----- -- --- V. SIT[ DESIGN CAPACITY <br /> A. Pw{,a NT PO PULATrON ew CA—Crr. •.Oa,IYN POPVLATION OA UL11-1.CwPACITT C.NF{ ■AP{CTANCT T{Aw• <br /> 600 to 800 tons 2000 tons _ _ _—__5 years <br /> FORM too (Ray. 1/461 (OVER) <br />