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STATE OF CALIFORNIA <br /> CALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD <br /> REGIONAL WATER QUALITY CONTROL BOARD <br /> APPLICATION FOR SOLID WASTE FACILITY PERMIT/WASTE DISCHARGE REQ IREMENTS <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 /> WIS"NUMBER, Ft INGFEE: RECEIPTNUMBER= DATE RSCEI D <br /> - 7-00 <br /> AP <br /> 7 <br /> 00 �� <br /> DA�'EACCEPTE DATE REJECTED: " ACCEPTANCE DATE OF <br /> iiINCOMPLETE <br /> APPLICATION: <br /> DATE DUE' <br /> Part 1. GENERAL INFORMATION <br /> A.ENFORCEMENT AGENCY: B.COUNTY: <br /> San Joaquin Coun Environmental Health Department San Joaquin <br /> C.TYPF OF APPLI ATI N(Check one box only): <br /> ®1. NEW SWFP and/or WDRS ®4.PERMIT REVIEW <br /> 112. REVISION OF SWFP and/or WDRS 05.AMENDMENT OF APPLICATION <br /> 113. EXEMPTION and/or WAIVER 26.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 WE EMDB& M; Southeast quarter of Section 31 T4N WE EMDB&M; Northeast quarter of the <br /> northwest quarter of Section 6 T3N WE EMDB& M <br /> C.TYPE OF ACTIVITY:(Check applicable boxes): <br /> ®1.DISPOSAL 1:33.TRANSFORMATION M5.OTHER(describe): <br /> a. TYPE: <br /> 1:12.COMPOSTING ®4.TRANSFER/PROCESSING FACILITY <br /> a. TYPE: ❑CHECK HERE IF RECYCLABLE MATERIALS ARE RECOVERED PRIOR TO TRANSFER/PROCESSING. <br /> D.CONFORMANCE FINDING INFORMATION(CIWMP): <br /> 1:11.FACILITY IS IDENTIFIED IN(Check one): <br /> ®SITING ELEMENT DATE OF DOCUMENT PAGE# <br /> ®NONDISPOSAL FACILITY El DATE OF DOCUMENT PAGE# <br /> R2.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 x❑6.CONSTRUCTION/DEMOLITION ®11.LIQUIDS <br /> r--12.ASBESTOS ❑Friable ❑Non-friable 1:17.CONTAMINATED SOILS ®12.MIXED/MUNICIPAL SOLID WASTE <br /> ❑3.ASH 1:38.DEAD ANIMALS ®13.SEWAGE SLUDGE <br /> r-14.AUTO SHREDDER ®9.INDUSTRIAL ®14.TIRES <br /> 010.INERT ®15.OTHER(describe): <br /> ®5.COMPOSTABLE MATERIAL(describe): Page 1 <br />