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STATE OF CALIFORNIA CALIFORNIA INTEGRATED TE MANAGEMENT BOARD <br /> SOLID WASTE FACILITIES PERMIT Ao ICATION <br /> CMMa E•1•77(REV.7/921 <br /> ENFORCEMENT AGENCY: FOR ENFORCEMENT AGENCY USE ONLY <br /> TLE NUMBEA(PERMIT NUMBER) DATE RECEIVED: <br /> Public Health Services - Env. Health Div. DATE ACCEPTED: <br /> COUNTY: DATE REJECTED: <br /> San Joaquin FILING FEE: <br /> TYPE OF APPLICATION: RECEIPT NUMBER: <br /> CO SWMP/COUNTYWIDE <br /> ®1. NEW SOLID WASTE FACILITY PERMIT 1:1 4. MODIFICATION OF PERMIT 117.AMENDMENT OF APPLICATION IWMP REFERENCE PAGEISI: <br /> �2. REVISION OF PERMIT FIS. EXEMPTION FROM PERMIT <br /> ❑3. PERMIT REVIEW 116. FACILITY CLOSURE <br /> NOTE:This form hes been developed for multiple uses. It is the transmittal sheet for documents required to be submitted to the <br /> local enforcement agency. See instructions for completing this application. <br /> 1. GENERAL NAME OF FACILITY, Scotts 5an a <br /> DESCRIPTION LOCATION OF FACILITY: IGive address or location, also include legal description by section. township, range,base, and <br /> OF meridian If surveyed or projected. <br /> FACILITY <br /> TYPE OF FACILITY: r7 LANDFILL ®PROCESSING FACILITY ®MATERIAL RECOVERY FACILITY <br /> SUMP ®TRANSFER STATION LAND SPREADING <br /> TRANSFORMATION ®COMPOSTING (Yard Trimmings) <br /> FACILITY <br /> TYPE OF WASTES TO BE RECEIVED: <br /> FIAGAICULTURAL ®DEAD ANIMALS MT1R£S <br /> ASBESTOS ®INDUSTRIAL ❑WOOD MILL <br /> MASH ®LIQUIDS IINCLUOES SEPTAGEI 0 OTHER DESIGNATED WASTE <br /> 7AUTO SHREDDER ®MIXED MUNICIPAL r7 OTHER HAZARDOUS WASTE <br /> CONSTRUCTION/DEMOLITION ®SLUDGE ®OTHER: IDESCAIS£l Trig <br /> If.FACILITY PROPOSED CHANGE EFFECTIVE DATE <br /> INFORMATION COMMENCED (CHECK APPLICABLE 8OXES1 OF PROPOSED CHANGE: <br /> Date: ®DESIGN <br /> ®WILL COMMENCE ®NO CHANGE <br /> osts:October 1994* <br /> ®OPERATION <br /> AVERAGE ANNUAL PEAK DAILY FACILITY SITE CAPACITY EXPECTED CLOSURE DATE: <br /> LOADINOCTPY): ** LOADINGCTPO): 500 SIZE (A): 22 acres IN YARDS: 55 O Indefinitely <br /> 111. OPERATOR OWNER OF LAND ADDRESS: TELEPHONE NUMBER: <br /> INFORMATION (Name): 23390 Flood Road <br /> 3845-- <br /> For lend dispoeai. Scotts H nex Linen CA 95236 209 887- <br /> If op.rstor Is FACILITY OPERATOR ADDRESS:23390 Flood Road <br /> dlNanertt from (Narrlel: <br /> land own.'. ."ach cotts/H nex Linden, CA 95236 ( PH 887-3845 <br /> lease or francNaa ADDRESS WHERE LEGAL NOTICE MAY BE SERVED: TELEEPHONE NUMBER: <br /> agreement. Sam as FacilityOperator <br /> I hereby acknowledge that I have read this application and the Report of Facility Information, and certify that the information given is <br /> true and accurate to the best of my knowledge and belief. In operating the solid waste facility, I agree to comply with the condidone <br /> of the permit and with federal, state, and local enactments. <br /> SIGNATURFMANO OWNE 0 AGE '' / SIGNA RE (FACILITY OPERATOR OR�GENTI: <br /> '��..f r/` • �" ,: <br /> TYPED NAME: TYPED NAM, L. Dau qhe <br /> Daugherty Gary �L. <br /> TITLE:' � i V G erA/V OA h. I G — TriLE: ' ` _ _ N DATE: <br /> IV.LIST OF ATTACHMENTS (CHECK IF APP ICA8LEI: <br /> ©REPORT OF FACILITY INFORMATION ®SWAT(AIR AND WATERT <br /> OPERIOOIC SITE REVIEW OSTORMWATER DISCHARGE PERMITS INPOES) <br /> [-X LOCAL USEIPLANNING PERMITS ®WIETLANOS PERMIT <br /> OPERATING LIABILITY FINANCIAL MECHANISM ®PRELIMINARY CLOSURE/POSTCLOSURE MAINTENANCE PLAN <br /> DEPARTMENT OF HEALTH SERVICES PERMIT QFINAL CLOSUR£IPOSTCLOSURE MAINENANCE PLAN <br /> Exempt ®AIR QUALITY/POLLUTION CONTROL DISTRICT PERMITS ®FINANCIAL RESPONSIBILITY DOCUMENTATION <br /> CERTIFIED ENVIRONMENTAL REVIEW REPORTS (CEQA) ®OTHER REGULATORY AGENCY PERMITS <br /> Exempt WASTE DISCHARGE REQUIREMENTS OTHER 1�mnPYf�/ Tamed <br /> TERMIT.XI.S87921 * Or when LEA issues SWFP <br /> ** 75,000 TPY <br />