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STATE OF CALIFORNIA <br /> ;ALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD <br /> REGIONAL WATER QUALITY CONTROL BOARD <br /> APPLICATION FOR SOLID WASTE FACILITY PERMITMASTE DISCHARGE REQUIREMENTS <br /> CIWMB E-1-77(Rev.M4) <br /> NOTE:This form has been developed for multiple uses. It is the transmittal sheet for documents required to be submitted to the appropriate agency. <br /> Please refer to the attached instructions for definitions of terms and for completing this application form in a complete and correct manner. <br /> FOR OFFICIAL USE ONLY <br /> SWIS NUMBER: FILING FEE: RECEIPT NUMBER: DATE RECEIVED: <br /> DATE ACCEPTED: DATE REJECTED: ACCEPTANCE DATE OF, <br /> INCOMPLETE ` <br /> APPI Ir]ATIrIN <br /> DATE DUE. <br /> Part 1. GENERAL INFORMATION <br /> A.ENFORCEMENT AGENCY: B.COUNTY: <br /> San Joaquin County Public Health Services, Environmental Health <br /> Dept. San Joaquin Count <br /> ❑1. NEW SWFP and/or WDRS 04.PERMIT REVIEW <br /> 112, REVISION OF SWFP and/or WDRS n5.AMENDMENT OF APPLICATION <br /> 1:13. EXEMPTION and/or WAIVER 26.RFI/ROWD/JTD AMENDMENTS <br /> Part 2. FACILITY DESCRIPTION <br /> A. NAME OF FACILITY: <br /> Forward Landfill <br /> B. LOCATION OF FACILITY: <br /> 1. PHYSICAL ADDRESS OR LOCATION AND ZIP CODE: <br /> 9999 South Austin Road, Manteca, CA 95336 <br /> 2. LATITUDE AND LONGITUDE: <br /> Latitude 37' 52'39.38", Longitude 121' 11'23.90" <br /> 3. LEGAL DESCRIPTION OF PERMITTED BOUNDARY BY SECTION,TOWNSHIP,RANGE,BASE,AND MERIDIAN,IF SURVEYED: <br /> Section 3 of Township 1 S, Range 7E,Mount Diablo Baseline and Meridian(MDB&M),Section 34 of Township 1 N,Range 7E MDB&M,and Section 10 of <br /> Township 1S,Range 7E MDB&M. Assessor Parcel Nos. 181-150-07, 181-150-08, 181-150-09,181-150-10,201-060-01,201-060-02,201-060-03,201- <br /> 060-04,201-060-05,and 201-070-01. <br /> C.TYPE OF ACTIVITY:(Check applicable boxes): <br /> ©1.DISPOSAL F__13.TRANSFORMATION 7X 5.OTHER(describe): ACW Disposal Site <br /> a. TYPE: Class II and Class III(see existing JTD pages 4-1 through 4-3) <br /> F_�2.COMPOSTING F_�4.TRANSFER/PROCESSING FACILITY <br /> a. TYPE: ❑CHECK HERE IF RECYCLABLE MATERIALS ARE RECOVERED PRIOR TO TRANSFER/PROCESSING. <br /> D.CONFORMANCE FINDING INFORMATION(CIWMP): <br /> ED.FACILITY IS IDENTIFIED IN(Check one): <br /> FX SITING ELEMENT DATE OF DOCUMENT 4/1/1996 PAGE 4 18-23 <br /> FINONDISPOSAL FACILITY E DATE OF DOCUMENT PAGE 9 <br /> 02.FACILITY IS NOT REQUIRED TO BE IDENTIFIED IN SITING ELEMENT OR NONDISPOSAL FACILITY ELEMENT <br /> E.TYPE OF PERMITTED WASTES TO BE RECEIVED:(Check applicable boxes): <br /> FX 1.AGRICULTURAL F-716.CONSTRUCTION/DEMOLITION F-111.LIQUIDS <br /> F-712.ASBESTOS ❑Friable ❑Non-friable 07.CONTAMINATED SOILS 012 MIXED/MUNICIPAL SOLID WASTE <br /> F713.ASH F-18.DEAD ANIMALS FX�13.SEWAGE SLUDGE <br /> 04,AUTO SHREDDER FX�9. INDUSTRIAL ❑X 14.TIRES <br /> FX�10. INERT QX 15.OTHER(describe): See existing JTD`-Sections 4.2 and 4.3 <br /> ('currently on file with LEA) <br /> 05.COMPOSTABLE MATERIAL(describe): Residential curbside green waste collection <br /> Page 1 <br />