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STATE OF CALIFORNIA <br /> CALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD <br /> RENAL WATER QUALITY CONTROL BOARD <br /> APPLICATION FOR SOLID WASTE FACILITY PERMIT/WASTE DISCHARGE REQUIREMENTS <br /> CIWMB E-1-77(Rev.8-04) <br /> NOTE:This form has been developed for multiple uses. It is the transmittal sheet for documents required to be submitted to the appropriate agency. <br /> Please refer to the attached instructions for definitions of terms and for completing this application form in a complete and correct manner. <br /> FOR OFFICIAL USE ONLY <br /> SWIS NUMBER: FILING FEE: �.� RECEIPT NUMBER: DATE RECEIVED: <br /> DATE ACCEPTED: DATE REJECTED: ACCEPTANCE DATE OF <br /> INCOMPLETE APPLICATION: <br /> " DATE DUE: <br /> Part 1.GENERAL INFORMATION <br /> A.ENFORCEMENT AGENCY: B.COUNTY: <br /> San Joaquin County Environmental Health Department San Joaquin <br /> C.TYPE OF APPLICATION(Check one box only): <br /> 1. NEW SWFP and/or WDRS �4.PERMIT REVIEW <br /> 02. REVISION OF SWFP and/Or WDRS 05.AMENDMENT OF APPLICATION <br /> 11 3. EXEMPTION and/or WAIVER ❑6.RFI/ROWD/JTD AMENDMENTS <br /> Part 2.FACILITY DESCRIPTION <br /> A. NAME OF FACILITY: <br /> Central valley Waste Services-SWIS 39-AA-0017 <br /> B. LOCATION OF FACILITY: <br /> 1. PHYSICAL ADDRESS OR LOCATION AND ZIP CODE: <br /> 1333 East Turner Road, P.O.Box 241001, Lodi,CA 95241 <br /> 2. LATITUDE AND LONGITUDE: <br /> N 38 degrees 08'41" W 12 degrees 15'11" <br /> 3. LEGAL DESCRIPTION OF PERMITTED BOUNDARY BY SECTION,TOWNSHIP,RANGE,BASE,AND MERIDIAN,IF SURVEYED: <br /> CA Northeast quarter of Section 6 T3N R7E EMDB &M;Southeast quarter of Section 31 T4N R7E EMDB &M; Northeast quarter of <br /> the northwest quarter of Section 6 T3N R7E EMDB &M <br /> C.TYPE OF ACTIVITY:(Check applicable boxes): <br /> F-11.DISPOSAL 03.TRANSFORMATION 05.OTHER(describe): <br /> a. TYPE: <br /> E-12.COMPOSTING X74.TRANSFER/PROCESSING FACILITY <br /> a. TYPE: ❑CHECK HERE IF RECYCLABLE MATERIALS ARE RECOVERED PRIOR TO TRANSFER/PROCESSING. <br /> D.CONFORMANCE FINDING INFORMATION(CNVMP): <br /> E-11.FACILITY IS IDENTIFIED IN(Check One): <br /> SITING ELEMENT DATE OF DOCUMENT PAGE N <br /> FINONDISPOSAL FACILITY ELEMI DATE OF DOCUMENT PAGE N <br /> 02.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 /> x]1.AGRICULTURAL FxD.CONSTRUCTION/DEMOLITION F-111.LIQUIDS <br /> 02.ASBESTOS ❑Friable ❑Non-friable E-17.CONTAMINATED SOILS F-112.MIXED/MUNICIPAL SOLID WASTE <br /> F-13.ASH E-18.DEAD ANIMALS �13.SEWAGE SLUDGE <br /> F-14.AUTO SHREDDER E-19.INDUSTRIAL �14.TIRES <br /> F�10.INERT E-115.OTHER(describe): <br /> 05.COMPOSTABLE MATERIAL(describe): Page 1 <br />