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STATE C,'CALIFORNIA OFORNIA INTEGRATED WASTE MANAGEMENT BOARD STANDARDIZED PERMIT APPLICATION CIWMB 92(NEW 9/95) SEE INSTRUCTIONS ON BACK FACILITY NAME ®� , FACILITY PHONE ®NUMBER ` t- AAL(06 FACILITY ADDRESS(INCLUDE STREET,P.O.BOX,CITY,STATE,ZIP CODE) FACILITY OPERATOR'S NAME OPERATOR'S PHONE NUMBER OPERATOR'S ADDRESS(INCLUDE STREET.P.O.BOX,CITY,STATE,ZIP CODE) 03 . \-o vu s2. kwAAke, , LAND OWNER'S NAME(IF DIFFERENT FROM OPERATOR) LAND OWNER'S PHONE NUMBER o\off. -,se. ® (�''�) (0G%=- LAND Ga LAND OWNER'S ADDRESS(INCLUDE STREET,P.O.BOX.CIT',STATE,ZIP CODE) ^ g -- v FACILITY INFORMATION CALIFORNIA CODE OEJREG®LATI O\N®SECTIOON`N�UMBBER�AUTHORIZING ELIGIBILITY: ' t� TYPE OF WASTE MATERIAL(S)HANDLED(PLEASE BE SPECIFIC): ,, •� VOLUME OF WASTE MATERIAL(S)HANDLED: SITE CAPACITY: 3S I O 0y CUBIC YARDS DAILY PEAK LOADING: 0%00 CUBIC YARDS I ANNUAL LOADING: \ 0 0 V CUBIC YARDS DAYS AND HOURS OF OPERATION: FACILITY SIZE. ® ACRES OPERATING AREA SIZE: A ACRES INCOMING WASTE MATERIAL(NUMBER OF VEHICLES PER DAY): ` OUTGOING WASTE MATERIAL(NUMBER OF VEHICLES PER DAY): / ONE OF THE FOLLOWING STATEMENTS MUST BE CHECKED: D� Issuance of the permit will not prevent or substaMielly impair achievement of the diversion goals of the jurisdiction from which it received solid waste;ft facility is' and in x or conforms with the county solid management waste plan,or otherwise complies with Public Resources Code section 50000;The farriity is consistent with the city or county general plan and is compatible with surrounding tend uses,or otherwise complies with Public Resources Code section 50000.1. The faciiiiy is identrfisa in either the countywide siting eiemem to nondisposal facility element,or in the source reduction and recycling eiament for the junsoietions in which it is located;or, that the faclity is not required to be identified in any of these elements pursuant to section 50DOI of the Public Resources Code. HIS APPLICATION MUST BE ACCOMPANIED BY A REPORT OF FACILITY INFORMATION, XSITE PLAN, KOCATION MAP,AND EITHER AVIDENCE OF COMPLIANCE WITH CEQA,OR ❑INFORMATION ON THE STATUS OF CEQA CERTIFICATION /hereby acknowledge that/have read this application, and car* under penalty of perjury that the information provided is true and accurate. In operating the facility, /agree to comply with the conditions of the permit, and with federal, state and local requirements and enactments. LAND OWNER'S SIGNATURE Xf DATE SIGNED OPERATOR'S SIGNATURE + / DATE SIGNE tw z Tp Q ENFORCEMENT AGENCY NAME AND ADDRESS q Vc jaceh, 04104 r , eP( Q CWMoA CPQ ate-->-.;L0 FOR ENFORCEMENT AGENCY"11.11W ONLY GATE RECEIVED: DATE APPROVED: DATE REJECTED: FILING FEE: SWIS fk