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'':STATE OF CALIFORNIA <br />REGIONAL WATER QUALITY CONTROL BOARD <br />DEPARTMENT OF HEALTH SERVICES <br />SOLID WASTE MANAGEMENT BOARD <br />'PARTMENT OF FORESTRY <br />APPLICATION FOR <br />FACILITY PERMIT/WASTE DISCHARGE <br />This form is to be used for filing a/an: (check all appropriate) <br />1. 0 REPORT OF WASTE DISCHARGE <br />(pursuant to Division 7 of the State Water Code) <br />2. u APPLICATION FOR A HAZARDOUS WASTE FACILITY PERMIT <br />(pursuant to Health and Safety Code Section 25200) <br />3. �� APPLICATION FOR A SOLID WASTE FACILITIES PERMIT <br />(pursuant to Government Code Section 66796.30) <br />4. U APPLICATION FOR A RUBBISH DUMP PERMIT <br />(pursuant to Public Resources Code Sections 4371-4375 and 4438) <br />1. FACILITY <br />Padfic Lichtinq` Energy System <br />ADDREss <br />Austin Road Waste Disposal Site <br />B. NAME OF LEGAL OWNER OF FACILITY <br />_ pacific Lati�,� <br />ADDRESS <br />_6055 E_ Wachinatnn _ _ BlvdSuite <br />C. NAME OF BUSINESS OPERA NG FACILITY <br />FOR OFFICE USE ONLY <br />Form 200 Recd <br />Fee (RWQCB) (SWMB)_ <br />Letter to Discharger <br />Report Recd <br />Effective Date <br />CDF Notified <br />DONS No. <br />SWMB No. <br />ADDRESS — — <br />— <br />Sewage, sewage sludge, and/or E. <br />septic tank pumpings <br />21P CODE <br />% --6D55 E. Washingon <br />SIP COOL <br />Commerce, CA 90040 <br />B. <br />TELLPHONE a <br />G FACILITY <br />(213 725-1139 <br />Animal wastes J. <br />Sole Proprietorship <br />21P COOL <br />® Corporation <br />Government Agency <br />TELEPHONE AI <br />C <br />ADDRESS — — <br />— <br />Sewage, sewage sludge, and/or E. <br />septic tank pumpings <br />21P CODE <br />% --6D55 E. Washingon <br />tBlvd., Suite 817, <br />Commerce, CA 90040 <br />B. <br />t YPE OF BUSINESS OPERAT <br />G FACILITY <br />Animal wastes J. <br />Sole Proprietorship <br />Partnership <br />® Corporation <br />Government Agency <br />E. NAME OF _0W_r49__RT_Sj OF BUSINESS OPERATING FACILITY <br />TELEPHONE a <br />ADDRESS WHERE LEGAL NOTICE MAY ®L SERVED <br />11. REASON FOR FILING <br />CHECK ALL APPROPRIATE: - <br />ANew discharge or facility <br />B.. Existing discharge or facility <br />C. increase in quantity of discharge <br />D. Change in character of discharge <br />E. Change in place or method of disposal <br />F. Change in design or operation <br />111. TYPE OF OPERATION <br />CHICK ALL APPROPRIATE: <br />A. Transfer station <br />B. Solid waste disposal site <br />C. Hazardous waste disposal site <br />D. Sewage treatment <br />E. Industry (on-site disposal facility) <br />F. Industry (discharge to sewer) <br />IV. TYPE OF WASTE <br />CHECK ALL APPROPRIATE: <br />SIP COOL <br />G. Change in business operating facility <br />H. Enlargement of existing facility <br />1. Other (explain below) <br />G.Woodwaste site <br />H. Other (explain below) <br />A <br />Sewage, sewage sludge, and/or E. <br />septic tank pumpings <br />Agricultural wastes 1. <br />Inert materials <br />B. <br />Industrial wastes F. <br />Animal wastes J. <br />Dead animals <br />j C. <br />\ <br />Municipal solid wastes G. <br />Forest product wastes K. <br />Tires <br />D. <br />Hazardous wastes H. <br />Construction/demolition wastes L <br />Other (explain below) <br />V. SITE DESIGN CAPACITY <br />A. PRESENT POPULATION OR CAPACITY L. OLS/ON POPULATION OR ULTIMATE CAPACITY C. L1PE LXPLCTANCY YEARS <br />800 KW - Net 800 KW - Net 20 Years <br />FORM ZOO (REV. 3/80) (OVER) <br />