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STAFi+JF CA*ORNIA • • <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. 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: <br />FILING FEE: <br />RECEIPT NUMBER: <br />DATE RECEIVED: <br />f� <br />A - O to <br />7i % 7i8J ip <br />DATE ACCEPTED: <br />DATE REJECTED: <br />ACCEPTANCE DATE OF <br />INCOMPLETE <br />APPLICATION: <br />DATE DUE: <br />Part 1. GENERAL INFORMATION <br />A. ENFORCEMENT AGENCY: B. COUNTY: <br />County of San Joaquin, Environmental Health Department San Joaquin <br />C. TYPE OF APPLICATION (Check one box only): <br />0 1. NEW SWFP and/or WDRS R4. PERMIT REVIEW <br />2. REVISION OF SWFP and/or WDRS 05. AMENDMENT OF APPLICATION <br />❑3. EXEMPTION and/or WAIVER I^ is, RFI/ROWD/JTD AMENDMENTS <br />Part 2. FACILITY DESCRIPTION <br />A. NAME OF FACILITY: <br />Material Recovery & Transfer Station <br />B. LOCATION OF FACILITY: <br />1. PHYSICAL ADDRESS OR LOCATION AND ZIP CODE: <br />30703 S Macarthur Drive, Tracy, CA 95376 <br />2. LATITUDE AND LONGITUDE: <br />Lat 37.67803 North, Long -121.41618 West <br />3. LEGAL DESCRIPTION OF PERMITTED BOUNDARY BY SECTION, TOWNSHIP, RANGE, BASE, AND MERIDIAN, IF SURVEYED: <br />n/a <br />C. TYPE OF ACTIVITY: (Check applicable boxes): <br />F-11. DISPOSAL F-13. TRANSFORMATION <br />a. TYPE: <br />XM2. COMPOSTING <br />a. TYPE: <br />X❑5. OTHER (describe): Cannery Waste <br />Pri4. TRANSFER/PROCESSING FACILITY <br />Green Waste X CHECK HERE IF RECYCLABLE MATERIALS ARE RECOVERED PRIOR TO TRANSFER/PROCESSING, <br />D. CONFORMANCE FINDING INFORMATION (CIWMP): <br />X❑ 1. FACILITY IS IDENTIFIED IN (Check one): <br />x❑SITING ELEMENT <br />F�NONDISPOSAL FACILITY EL <br />DATE OF DOCUMENT Mar -97 <br />DATE OF DOCUMENT <br />F2. 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 <br />F-12. ASBESTOS ❑ Friable ❑ Non -friable <br />03. ASH <br />04. AUTO SHREDDER <br />x�5. COMPOSTABLE MATERIAL (describe): <br />F-16. CONSTRUCTION/DEMOLITION <br />E-17. CONTAMINATED SOILS <br />F-18. DEAD ANIMALS <br />E9. INDUSTRIAL <br />10. INERT <br />Green Waste <br />FT I. LIQUIDS <br />12. MIXED/MUNICIPAL SOLID WASTE <br />M 13. SEWAGE SLUDGE <br />14. TIRES <br />115. OTHER (describe): Appliances, u -waste, a -waste <br />PAGE # <br />PAGE # <br />Page 1 <br />