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RECEIVED <br /> STATE OF CALIFORNIA JUL16 0f�� <br /> CALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD <br /> REGIONAL WATER QUALITY CONTROL BOARD <br /> APPLICATION FOR SOLID WASTE FACILITY PERMIT/WASTE DISCHARGE REQUIREMENTS ENTAL HEALTH <br /> CI WMB E-1-77(Rev.8-04) raEr.®...s,.......,.„.... <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 /> J 12 <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 /> L) ion <br /> C.TYPE OF APPLICATION(Check one box only): <br /> 1. NEW SWFP and/or WDRS F�4.PERMIT REVIEW <br /> ®2. REVISION OF SWFP and/or WDRS 115.AMENDMENT OF APPLICATION <br /> 113. EXEMPTION and/or WAIVER 116.RFI/ROWD/JTD AMENDMENTS <br /> Part 2.FACILITY DESCRIPTION <br /> A. NAME OF FACILITY: <br /> c,?esf - Com-+ r® <br /> B. LOCATION OF FACILITY: <br /> 1. PHYSICAL ADDRESS OR LOCATION AND ZIP CO/DE: <br /> 1 / <br /> 2. LATITUDE AND LONGITUDE: <br /> J7- �"t 7 121 . 30 7 81 2- <br /> 3. LEGAL DESCRIPTION OF PERMITTED BOUNDARY BY SECTION,TOWNSHIP,RANGE,BASE,AND MERIDIAN,IF SURVEYED: <br /> 2-0 0-C v'zs e,✓ _e s rN lcrl 7 reN oe 191W 12/- <br /> C.TYPE OF ACTIVITY:(Check applicable boxes): <br /> F�1.DISPOSAL ®3.TRANSFORMATION IM5.OTHER(describe): 'l VOI G <br /> a. TYPE: P✓l�j�.6.!// ope,- 1141 <br /> n2.COMPOSTINGqq F-14.TRANSFER/PROCESSING FACILITY <br /> a. TYPE: Q/'e a Q + F012p 0 CHECK HERE IF RECYCLABLE MATERIALS ARE RECOVERED PRIOR TO TRANSFER/PROCESSING. <br /> D.CONFORMANCE FINDING INFORMATION(CIWMP): <br /> t�"1.FACILITY IS IDENTIFIED IN(Check one): <br /> ®SITING ELEMENT DATE OF DOCUMENT PAGE# <br /> '7�INONDISPOSAL FACILITY EL DATE OF DOCUMENTQ I Z PAGE# I,Z <br /> 72.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 /> �1.AGRICULTURAL X6.CONSTRUCTION/DEMOLITION ®11.LIQUIDS <br /> ®2.ASBESTOS 0 Friable O Non-friable F-17.CONTAMINATED SOILS F-112.MIXED/MUNICIPAL SOLID WASTE <br /> ®3.ASH ®8.DEAD ANIMALS 1:113.SEWAGE SLUDGE <br /> 1-14.AUTO SHREDDER 1:19.INDUSTRIAL ❑14.TIRES <br /> [::]10.INERT q�15.OTHER(describe): <br /> n5.COMPOSTABLE MATERIAL(describe): <br /> �r--�' Page 1 <br />