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`STATE CF CALIFORNIA LIFORNIA INTEGRATED WASTE MANAGEMENT BOARD STANDARDIZED PERMIT APPLICATION Ci1WM8 92(NEW Wos) SEE INSTRUCTIONS ON BACK FACILITY NAME FACILITY PHONE NUMBER 0I t,(..-�k O•n ga-tA 4 AL(o h FACILITY ADDRESS(INCLUDE STREET,P.O.BOX,CITY, STATE,ZIP CODE) �- o-t, V�• 04, FACILITY OPERATOR'S NAME OPERATOR'S PHONE NUMBER OPERATOR'S ADDRESS(INCLUDE STREET.P.O.BOX,CITY,STATE,ZIP CODE) \-o v;.se- ArWAN.2 LAND OWNER'S NAME(IF DIFFERENT FROM OPERATOR) LAND OWNER'S PHONE NUMBER LANG OWNER'S ADDRESS(INCLUDE STREET.P.O.COX.CITY,STATE.LIP CODE) CA FACILITY INFORMATION CALIFORNIA CODE OE.REGULATIONS�SECTN`v BER\�AUTHOi1ZINGELP IGIBAI C c-� TYPE OF WASTE MATERIreQAA HANDLED SQECIFICa: VOLUME OF WASTE l/MATERIAUS)HANDLED: C�`-- SITE CAPACITY: 3S 1 O O(7 CUBIC YARDS I DAILY PEAK LOADING: O CUBIC YARDS I ANNUAL LOADING:`YV,O O V CUBIC YARDS DAYS AND HOURS OF OPERATIO rr 2� J L (A\M FACILITY Sim. 3( ACRES OPERATING AREA SIZE: ACRES NCOMING WASTE MATERIAL(NUMBER OF VEHICLES PER DAY): ` OUTGOING WASTE MATERIAL(NUMBER OF VEHICLES PER DAY): / l ONE OF THE FOLLOWING STATEMENTS MUST BE CHECKED: Issuance of the permit will not prevent or substantially impair achievement of the diversion goals of the jurisdiction from which it received solid waste;the facility is identified and described in or conforms with the county solid management waste plan,or otherwise complies with Public Resources Code section 50000;The facility is consistent with the city of county general plan and is compatible with surrounding land uses,or otherwise complies with Public Resources Code section 50000.1. The facility is identnfieo in either the aouritywide sting Bement,the nordisposal facility element,or in ate source reouction and recycling element for the jurisdictions in which it Is located:or, that Vie facility is not required to be identified in any of these elements pursuant to section-",=I of the Public Resourcas Code. �'HHIIS APPLICATION MUST BE ACCOMPANIED BY A }al(2EPORT OF FACILITY INFORMATION, SITE PIAN. KOCATION MAP,AND EITHER VIDENCE OF COMPLIANCE WITH CEOA.OR OINFORMATION ON THE STATUS OF CEOA CERTIFICATION hereby acknowledge that/have read this application, and certify under penalty of perjury that the information provided is true and accurate. In )perating the facility, l agree to comply with the conditions of the permit, and pith federal, state and local requirements and enactments. LEASE HOLDER ' S ,S GPJATURE �x AND OWNER'S SIGNATURE ,Y DATE SIGNED )PERATOR'S SIGNATURE / DATE SIGNE -f GIL- z �� Q NFORCEMENT AGENCY NAME AND ADDRESS Q�JpSAG \\� SfA J�40V, 304 F . WQ� OQW k )-NA Q S c iv C'N g5:ti0 FOR ENFORCEMENT AGENCY USE ONLY la ten M CF fVL l) DATE APPROVED DATE REJECTED. FILING FEE SWIS 0