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STA TI VF CALIF"G'RNIA SOLID --.IV MANSC.E MEµT BOARD <br /> SOLID WASTE FACILITY PERMIT APPLICATION <br /> !,q 'ImB C-1-19 (NEW 6-71) <br /> rNl ORCCMENT AGCNCY <br /> ( FOR ENFORCEMENT AGENCY USE C7NI.Y <br /> SAN JOAQUIN COUNTY HEALTH DISTRICT i FILE NUMBER (PERMIT NUMBER) <br /> i <br /> SAN JOAQUIN I DATE RECEIVED- --- - - - - - - ----- <br /> DAECEIVED FILING FEE <br /> 6ran t%VMjr"``Entitlement" (Govt Code 66795) lS !7`7 <br /> 2. APPLICATION r DATE ACCEPTED RECEIPT NUMBER <br /> OPERAITION R L� PER FORILft ® WASTE 1 OF PERMIT S. kAPPLICATION FOR MODIFICATION <br /> MIT <br /> A, AMENDMENT L DATE PERMIT ISSUED Co SWMP REFERENCE PAGE Bra_ <br /> OF <br /> APPLICATION S. APPLICATION FOR REVIEW <br /> NOTE: This form has been developed for multiple uses. It is the transmittal sheet for documents required <br /> to be submitted to the enforcement agency. *A Report of Station or Disposal Site Information <br /> or an amendment thereto must be submitted with this form, <br /> rL <br /> AME OF FACILITY <br /> Cal.'-Clay Disposal SiteOCATION OF FACILITY (GIVE ADDRESS OR LOCATION DESCRIPTION BY SECTION, TOWNSHIP, RANGE, COUNTY-J <br /> 3200 S. El Dorado St , , Stockton, California <br /> TYPE OF FACILITY <br /> I, ® SOLID WASTE DISPOSAL SITE ❑ TRANSFERIPROCESSING STATION (INCLUDES RESOURCE RECOVERY) <br /> GENERAL <br /> TYPE QF WASTES TO BE RECEIVED <br /> DESCRIPTION <br /> ! ❑ RESIDENTIAL REFUSE ❑ CO NSTRU CT00NJDEMOLIT(ON WASTES ❑ HA YAR DO US WASTES <br /> OF <br /> FACILITY COMMERCIAL SOLID WASTES ❑ SEWAGE SLUDGE" ❑ AGRICULTURAL WASTES <br /> Class III & Limited Class II (automobile demolition wastes ) <br /> ❑ TIRES State' Permits- 6/15/7` LIQUIDS/SLURRIES ❑ SEPTIC TANK PUMPINGS <br /> � ��-LUU� <br /> EJ OTHER (SPECIFY)--_,__ <br /> Ig. OPERATION I EFFECTIVE PROPOSED CHANGE (CHECK ONE OR BOTH] I EFFECTIVE <br /> DATE DATE <br /> ACi L1TY <br /> INFORMATION ❑ I 1960 ❑ ❑ <br /> COMMENCED WILL COMMENCE 1 DESIGN OPERATION <br /> •-- —,_--- 0vrN1—zRof P-R"oPERrv—(NAMej_ r ADDRESS <br /> ! California Clay Products 1305 N. Fl Dorado St . , Suite 301 <br /> III. ®�ERAY®RINAr�EI- -- _ - - -I-AD®I7ESs <br /> - Stockton .; c-5.2.0? - ---- <br /> rA <br /> OPERATOR s I <br /> same I <br /> INFORMATION L--- <br /> 1 ADDRESS WHERE LEGAL NOTICE MAY BE SERVED <br /> # 305 N. El Dorado St , , Suite 301, Stockton, California 95202 <br /> FIL,NG FEE ENCLpsED <br /> I hereby acknowledge that I have read this application and the Report of Station or Disposal Site Informa- <br /> tion, and certify that the information given is true and accurate to the best of my knowledge and belief. <br /> In operating the solid waste facility, 1 agree to comply with the conditions of the permit and with state <br /> and local enactments. <br /> SIGNATU E ( WNER O GEN - SIGNATURE (OPERATOR OR AGENT) <br /> lob <br /> TYPED NA ... TYPED NAME <br /> JACK C. DOZIER <br /> -DATE — <br /> Attorney for Calif, Clay Product 8/15/77 <br /> C_-_HEC__ _K APPROPRIATE-_ .- .-_ BOX----- <br /> ENFORCEMENT <br /> APPLICATION APPROVED APPLICATION DENIED <br /> AGENCY <br /> 1 SIGNATURE - TITLE AND PRINTED NAME _ DATE AND TELEPHONE NO. <br /> USE ONLY <br /> DATE RECEIVED CHECK APPROPRIATE BOX _ <br /> SOLID ❑ <br /> I ❑ OBJECT TO <br /> BASTE PROPOSED PERMIT <br /> CONCUR WITH ❑ PROPOSED PERMIT AGENCY DENIAL UPHELD <br /> j <br /> MANAGEMENT ' <br /> BOARD .._. -. _ _.. .__ __ _0THER1SPE CIFY)_:==- -- --- --- --. ---_-- ---_- - __-=-w_. .. <br /> S-G NATURE -- --- TITLE AND PRINTED NAME DATE AND TELEPHONE NO. <br /> USE ONLY <br />