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,k <br /> qq 1�", \) SOLID NATE M.AN AGE ME <br /> �'TA Ti. VI' CALIFORNIA NT $OAPD <br /> �`y � \\II <br /> SOLID WASTE FACILITY PERMIT APP A y <br /> SSI1R C-I-l7 (NEW a-7I) <br /> F.NI 0NCC:MENT AGENCY y\�{� L� ` 1 FOR2 ENFORCEMENT AGENCY USE ONLY <br /> San Joaquin Local Health Dls I t 1(] 1 .V NUMBER (PERMIT NUMBER) <br /> San Jo aq uin CountyP�, ��� pE <br /> - !i DATE RECEIVED FILING FEE <br /> TYPE OF APPLICATION <br /> Z. APPLICATION ATE ACCEPTED RECEIPT NUMBER <br /> 1. AITION F L� FACI LITT OF PERMIT <br /> CE FOR SOLID WASTE APPLICATION FOR MODIFICATION <br /> OPHR <br /> R <br /> PERMIT <br /> 4, AMENDMENT DATE PERMIT ISSUED CO SWMP REFERENCE PAGE S --^OFP LIGATION S. APPLICATION FOR REVIEW <br /> NOTE: This form has been developed for multiple uses. It is the transmittal sheet for documents required <br /> to be submitted to the enforcement agency. *A Report of Station or Disposal Site Information <br /> or an amendment thereto must be submitted with this form. <br /> - — - - - - - - -- - - <br /> -- ------ NAME OF FACILITY <br /> City of Ripon <br /> LOCATION OF FACILITY (GIVE ADDRESS OR LOCATION DESCRIPTION BY SECTION, TOWNSHIP, RANGE, COUNTY] <br /> South Vera Ave. , San Joaquin County, Ripon, California. <br /> TYPE OF FACILITY <br /> 1. <br /> SOLID WASTE DISPOSAL SITE TRANSFERIPROCESSING STATION (INCLUDES RESOURCE RECOVERY( <br /> TYPE of <br /> GENERAL E OF WASTES <br /> ( w$rE.ToO BE RECEIVED <br /> DESCRIPTION <br /> � Q RESIDENTIAL REFUSE Q CONSTRUCTION/DEMOLITION wA54E8 HAZARDOUS WASTES <br /> OF <br /> FACILITY I Q COMMERCIAL SOLID WASTES SEWAGE SLUDGE ❑ AGRICULTURAL WASTES <br /> aTIRES LIQUIDS/SLURRIES SEPTIC TANK PUMPING. <br /> i <br /> OTHER (SPECIFY) Leavers , Tree Trimmings. <br /> II OPERATION I EFFECTIVE PROPOSED CHANGE (CHECK ONE OR BOTH I EFFECTIVE <br /> FACILITY I DATE I DATE <br /> INFORMATION COMMENCED WILL COMMENCE I DESIGN OPERATION I <br /> ._— OWNER OF PROPERTYTAMEj_ 1 ADDRESS <br /> lCity of Ripon _ _ . _ -i P. 0. Box 727 , Ripon , Ca. 95366 <br /> F <br /> III. .. . _. - - -_---- <br /> OPERATOR NAME <br /> , ADDRESS <br /> OPERATOR � <br /> City of _ ion _ _._ _ _. -° P. . Box 727 , Ripon , -Ca . 95366 <br /> INFORMATION -- _ ___-- <br /> + ADDRESS WHERE LEGAL NOTICE MAY BE SERVED <br /> 311 W. First Street , Ripon, Ca. 95366 <br /> 44• FILING FEE ENCLOSED <br /> IV, { <br /> I I hereby acknowledge that I have read this application and the Report of Station or Disposal Site Informa- <br /> tion, and certify that the information given is true and accurate to the best of my knowledge and belief. <br /> In operating the solid waste facility, I agree to comply with the conditions of the permit and with state <br /> and local enactments. <br /> .lGNA UR WRIER OR AGENT' qEA <br /> (OPERATOR OR wGEN <br /> —.._ ' ------ -- - -- - —_ - ---- -•- --- -- ---- - -- .. _ - - --- ME <br /> City of Ripon , by Clarence Smit City of Ripon By Clarence Shit <br /> TITLE _..__.. -...- <br /> -. �_pAYg_ _ TITLE DATE <br /> City Administrator 2-77 City Administrator -2-77 <br /> _ ___ _ _ . ._ _ _ ___ &- - _ _- . ._ _- ___-. - __ __--_ _- _ _ - <br /> CHECK APPROPRIATE BOX <br /> ENFORCEMENT <br /> APPLl CATION APPROVED APPLICATION DENIED <br /> AGENCY -_______.__..-.__.__..-._ <br /> SIGNATURE TITLE AND PRINTED NAME DATE AND TELEPHONE NO, <br /> USE ONLY <br /> DATE RECEIVED CHECK..APPROPRIATE SOX <br /> SOLID (TH OBAECT TO <br /> WASTE <br /> + Q PROPOSED PERMIT Q PROPOSED PERMIT AGENCY DENIAL UPHELD <br /> MANAGEMENT 11, `rte' <br /> BOAR® 1'---- _. __. _ _.CA OTHER_JSFECIFY)_: <br /> $1GhATiIRE - -- -- _ _-- I TITLE AND PRINTED NAME DATE AND TELEPHONE NO. <br /> USE ONLY <br /> E <br />