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,D. <br /> � <br /> STATE OF CALIFORNIA �i I L <br /> CACIF.ORNIA INTEGRATED WASTE MANAGEMENT BOARD • • <br /> REGIONAL WATER QUALITY CONTROL BOARD <br /> APPLICATION FOR SOLID WASTE FACILITY PERMIT/WASTE DISCHARGE REQUIREMENTS Ni!-�° k u 1 <br /> CI*MB E-1-77(Rev.$44 <br /> NOTE:This form has been developed for multiple uses. It is the transmittal sheet for documents required to be submitted to the appropna P�1Cy <br /> Please refer to the attached instructions far definitions of terms and for completing this application form in a complete and correct manner. = • " <br /> [ATEACCEPTED: <br /> AL USE ONLY <br /> R: y� /� FILING FEE: RECEIPT NUMBER: DATE REyC�EIVIVVED: <br /> AA.`_C�G,-z-llo / 14 �2 C DATE REJECTED: ACCEPTANCE DATE OF <br /> INCOMPLETE APPLICATION: <br /> FDATE DUE: <br /> Part 1.GENERAL INFORMATION <br /> A.ENFORCEMENT AGENCY: B.COUNTY: <br /> r-nV1f0nM4uA �e A�� ep MtPVA lwqula coov& <br /> C.TYPE OF APPLICATION(Check one box only): <br /> 1. NEW SWFP and/or WDRS ❑4.PERMIT REVIEW <br /> LN 2. MODIFICATION OF SWFP n5.AMENDMENT OF APPLICATION <br /> 113. EXEMPTION and/or WAIVER 116.RFVROWD/JTD AMENDMENTS <br /> Part 2.FACILITY DESCRIPTION <br /> A. NAME OF FACILITY: <br /> S in Cou A t a I oin oA Cam PoA 00,' 6SI <br /> B. LOCATION OF FACILITY: <br /> 1. PHYSICAL ADDRESS OR LOCATION AND ZIP CODE: <br /> a3390 f, -1000d ed, Lkv�jtvl , C <br /> 2. LATITUDE AND LONGITUDE: <br /> SOU a4M IJ iaI o f 3I 5 3 w <br /> 3. LEGAL DESCRIPTION OF PERMITTED BOUNDARY BY SECTION,TOWNSHIP,RANGE,BASE,AND MERIDIAN,IF SURVEYED: <br /> GU�1 v 04 1rn V ( v1� `bot S <br /> C.TYPE OF ACTIVITY:(Check applicable boxJs): <br /> M1.DISPOSAL M3.TRANSFORMATION 05.OTHER(describe): <br /> a. TYPE: <br /> [112.COMPOSTING 4.TRANSFERIPROCESSING FACILITY <br /> a. TYPE: 6U-01. (]�((((]F❑CHECK HERE IF RECYCLABLE MATERIALS ARE RECOVERED PRIOR TO TRANSFER/PROCESSING. <br /> D.CONFORMANCE FINDING INFORMATION(CIWMP): <br /> ®1.FACILITY IS IDENTIFIED IN(Check one): <br /> ❑SrrING ELEMENT DATE OF DOCUMENT PAGE# <br /> MNONDISPOSAL FACILITY ELEMENT DATE OF DOCUMENT �y oo� PAGE#�� <br /> 1:12.FACILITY IS NOT REQUIRED TO BE IDENTIFIED IN SITING ELEMENT OR NONDISPOSAL FACILITY ELEMENT <br /> E.TYPE OF PERMITTED WASTES TO BE RECEIVED:(Check applicable boxes): <br /> M1.AGRICULTURAL M6.CONSTRUCTION/DEMOLITION M11.LIQUIDS <br /> E-12.ASBESTOS 0 Friable 0 Non-friable M7.CONTAMINATED SOILS rl12.MIXED/MUNICIPAL SOLID WASTE <br /> 03.ASH 1:18.DEAD ANIMALS 013.SEWAGE SLUDGE <br /> ❑4.AUTO SHREDDER 1:19.INDUSTRIAL M14.TIRES <br /> �10.INERT M15.OTHER(describe): <br /> (�S. COMPOSTABLE MATERIAL(desalbe): N Ouft������ 961 f.Y143S t' WY�� <br />