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• <br /> STATE OF CALIFORNIA <br /> CALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD <br /> REGIONAL WATER QUALITY CONTROL BOARD <br /> APPLICATION FOR SOLID WASTE FACILITY PERMIT/WASTE DISCHARGE REQUIREMENTS <br /> CIWMB E-1-77(Rev.&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: FEB - 5 J 2014 <br /> 3q- AIR --0 5 <br /> DATE ACCEPTED: DATE REJECTED: ACCEPTANCE DATE OF <br /> INCOMPLETE APPLICATION: <br /> MAR 0 4 2014 DATE DUE: <br /> Part 1.GENERAL INFORMATION <br /> A.ENFORCEMENT AGENCY: l B.COUNTY: <br /> ..� (Q rr) Y"l�Gl I CQ 1 I Y� C�"� ) <br /> C.TYPE OF APPLICATION(Check one box only): <br /> ❑1. NEW SWFP and/or WDRS 04.PERMIT REVIEW <br /> 92. REVISION OF SWFP and/or WDRS 05.AMENDMENT OF APPLICATION <br /> 113. EXEMPTION and/or WAIVER [16.RFI/ROWD/JTD AMENDMENTS <br /> Part 2.FACILITY DESCRIPTION <br /> A. NVV <br /> AME OF FACILITY: <br /> otY-\)-k- _ �- cl, � -) P <br /> B. LOCATION OF FACILITY: <br /> 1. PHYSICAL ADDRESS OR LOCATION AND ZIP CODE: n <br /> 2. LATITUDE AND LONGITUDE: <br /> 3. LEGAL DESCRIPTION OF PERMITTED BOUNDARY BY SECTION,TOWNSHIP,RANGE,BASE,AND MERIDIAN,IF SURVEYED: <br /> a n UG'C'P-5 r)n01a- <br /> C.TYPE OF ACTIVITY:(Check applicable boxes): <br /> F-11.DISPOSAL F--13.TRANSFORMATION [-]5.OTHER(describe): <br /> a. TYPE: <br /> ICI2.COMPOSTING F-14.TRANSFER/PROCESSING FACILITY <br /> `tea. TYPE: CA('e e �04 ❑CHECK HERE IF RECYCLABLE MATERIALS ARE RECOVERED PRIOR TO TRANSFER/PROCESSING. <br /> D.CONFORMANCE FINDING INFORMATION(CIWMP): <br /> r-11.FACILITY IS IDENTIFIED IN(Check one): <br /> SITING ELEMENT DATE OF DOCUMENT PAGE# <br /> FiNONDISPOSAL FACILITY EL DATE OF DOCUMENT PAGE# <br /> F-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 F-16.CONSTRUCTION/DEMOLITION M11.LIQUIDS <br /> E2.ASBESTOS ❑Friable ❑Non-friable 07.CONTAMINATED SOILS F-112.MIXED/MUNICIPAL SOLID WASTE <br /> M3.ASH E]8.DEAD ANIMALS F-113.SEWAGE SLUDGE <br /> M4,AUTO SHREDDER F--j9.INDUSTRIAL 014.TIRES <br /> 010.INERT �15.OTHER(describe): <br /> �.COMPOSTABLE MATERIAL(describe): ��Q` ) �' (t� I U 1-4) �`ft Yl <br /> Page 1 <br />