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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 PERMITIWASTE 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 />WIS NUMBER: <br />FILING FEE: <br />RECEIPT NUMBER: <br />DATE RECEIVED: <br />DATE ACCEPTED:. <br />DATE REJECTED: <br />ACCEPTANCE DATE OF <br />INCOMPLETE APPLICATION: <br />L=� <br />. -- <br />DATE DUE: <br />Part 1. GENERAL INFORMATION <br />A. ENFORCEMENT AGENCY: <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />one <br />01 . NEW SWFP and/or WDRS <br />1-12. REVISION OF SWFP and/or WDRS <br />COUNTY: <br />SAN JOAQUIN COUNTY <br />04. PERMIT REVIEW <br />05. AMENDMENT OF APPLICATION <br />1:13. EXEMPTION and/or WAIVER �6. RFI/ROWD/JTD AMENDMENTS <br />Part 2. FACILITY DESCRIPTION <br />A. NAME OF FACILITY: -- <br />North County Recycling. Center and Sanitary Landfill <br />B. LOCATION OF FACILITY: <br />1. PHYSICAL ADDRESS OR LOCATION AND ZIP CODE: <br />17916 East Harney Lane, Lodi, California 94240 <br />2. LATITUDE AND LONGITUDE: <br />Latitude: 38 degrees, 06 minutes Longitude: 121 degrees, 04 minute <br />3. LEGAL DESCRIPTION OF PERMITTED BOUNDARY BY SECTION, TOWNSHIP, RANGE, BASE, AND MERIDIAN, IF SURVEYED: <br />APN 065-120-02, 065-120-03, 065-120-08, and 065-120-09 in Section 21, T3N, R8E, MDB&M <br />C. TYPE OF ACTIVITY: (Check applicable boxes): <br />PMI. DISPOSAL 03. TRANSFORMATION M5. OTHER (describe): <br />a. TYPE: Class III <br />F-12. COMPOSTING O4. 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. FACILITY IS IDENTIFIED IN (Check one): <br />®SITING ELEMENT <br />®NONDISPOSAL FACILITY EL <br />DATEOFDOCUMENT April -96 <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 />F-11. AGRICULTURAL E-16, CONSTRUCTION/DEMOLITION 11. LIQUIDS <br />M2. ASBESTOS O Friable O Non -friable FIT CONTAMINATED SOILS ®12. MIXED/MUNICIPAL SOLID WASTE <br />❑3. ASH E-18. DEAD ANIMALS F-113. SEWAGE SLUDGE <br />❑4. AUTO SHREDDER F�9. INDUSTRIAL 1:114. TIRES <br />F-110. INERT 015. OTHER (describe): <br />1:15. COMPOSTABLE MATERIAL (describe) <br />PAGE # 18 <br />PAGE # <br />Page 1 <br />