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<br />This application form is for a Solid Waste Facilities Permit to receive, store, process, or dispose of solid wastes regulated by the California Waste Management
<br />Board (Board). This form and the filing fee should be sent to the appropriate city or county Local Enforcement Agency (LEA). The exact amount of the filing te-
<br />determined by the LEA.
<br />Complete this form and return it with a photocopy and two copies of the appropriate attachments determined to be necessary by your LEA. All material should be
<br />submitted on 8'/z" x 11" paper. Maps and other oversize documents should be folded to that size.
<br />The effective date of the application isthe date when all required information and the correct fee are received by the LEA. The LEA will notify you of this effective
<br />date.
<br />If you have any questions on the completion of this form, please contact the LEA or Board staff for assistance at (916) 322.3330.
<br />No instructions will be listed for items that are self-explanatory.
<br />I. GENERAL DESCRIPTION OF FACILITY
<br />TYPE OF WASTES TO BE RECEIVED:
<br />agricultural — wastes resulting from the production and processing of farm or agricultural products, including animal manures, prunings, and crop residues.
<br />asbestos — a naturally occurring family of carcinogenic fibrous mineral substance. The State Department of Health Services has classified triable wastes which
<br />contain more than one percent asbestos by weight as hazardous wastes. Friable means that the material can be crumbled with pressure and, therefore, is likely to
<br />emit fibers.
<br />ash — the residue from the incineration of solid wastes, including municipal waste, infectious waste, woodwaste, sludge, and agricultural wastes.
<br />auto shredder — the "fluff" consisting of upholstry, paint, plastics, and other non-metallic substances which remains after the shredding of automobiles,
<br />discarded household major appliances, and sheetmetal. The State Department of Health Services has classified untreated shredder wastes as hazardous.
<br />construction/demolition wastes — waste building materials, packaging and rubble resulting from construction, remodeling, repair, and demolition
<br />operations, and consisting mainly of inert materials.
<br />dead animals — animal carcasses requiring disposal that have not been previously used for medical purposes or with known infectious diseases
<br />industrial — solid or semi-solid wastes resulting from industrial processes and manufacturing operations, e.g., cement kiln dust, ore process residues, grit or
<br />screenings removed from a waste water treatment facility, etc.
<br />infectious wastes — wastes which have disease transmission potential are classified as hazardous wastes by the State Department of Health Services
<br />Infectious wastes include: pathological and surgical wastes, medical clinic wastes, wastes from biological laboratories, syringes, needles, blades, fubmg, his,
<br />bottles, drugs, patient care items such as linen or personal or food service items from contaminated areas. chemicals, personal hygiene wastes, and am
<br />carcasses used for medical purposes or with known infectious diseases.
<br />liquids — wastes which are not spadeable, usually containing less than 50 percent solids. These wastes include cannery and food processing wastes, landfill
<br />leachate and gas condensate, boiler blowdown water, grease trap pumpings, oil and geothermal field wastes, septic tank pumpings, rendering plant byproducts.
<br />some sewage sludge, etc. may be hazardous.
<br />mixed municipal — residential and commercial refuse, garbage and/or rubbish. Residential waste is commonly thought of as household garbage; commercial
<br />waste contains less putrecible waste and more paper and cardboard.
<br />sewage sludge — human (not industrial) residue, excluding grit or screenings, removed from a waste water treatment facility or septic tank, whether in a dry or
<br />semidry form.
<br />tires — discarded tire casings.
<br />wood mill — shavings, sawdust, sanderdust, chips, bark, slabs, deck scrapings, edgings, wood and other flammable waste material incidental to the processing
<br />of wood products.
<br />11. FACILITY INFORMATION
<br />PROPOSED CHANGE IN DESIGN OR OPERATION, OR NO CHANGE; EFFECTIVE DATE:
<br />For existing permitted facilities, when the operator proposes changes in design, operation, operator, or owner, details of the changes must be sent to the LEA It
<br />significant, the permit must be revised prior to implementation of the change. For an application for permit review, if there are no changes, so indicate.
<br />AVERAGE ANNUAL LOADING (TPY):
<br />The average amount of wastes the facility will receive on a yearly basis over the next five years, expressed in tons. Must be consistent with the RFI and any
<br />California Environmental Quality Act (CEQA) requirements. Volume figures should be converted to tons and the conversion factor should be documented in the
<br />accompanying Report of Facility Information.
<br />PEAK DAILY LOADING (TPD):
<br />The maximum amount of waste the facility is designed to receive, store, process, or dispose of per day, expressed in tons.
<br />FACILITY SIZE:
<br />The area of the facility in acres to be used for receiving, storing, processing, or disposing of wastes, including all monitoring locations and any buffer zone This �.
<br />be referred to as the "permitted acreage" and is considered the facility boundaries.
<br />Ill. OPERATOR INFORMATION
<br />For land disposal operations, if operator is different from land owner, attach lease or franchise agreement documenting operator's interest in the real property
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