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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 PERMITMASTE DISCHARGE REQUIREMENTS <br />CIWMB E-1.77 (Rev. 8-04) <br />�MY9MPAMYMARIIIIP A <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 />39 -AA -002 <br />C. TYPE OF APPLICATION (Check one box only): <br />❑ 1, NEW SWFP and/or WDRS <br />DATE ACCEPTED: <br />DATE REJECTED: <br />ACCEPTANCE DATE OF <br />113. EXEMPTION and/or WAIVER <br />R6. RFI/ROWD/JTD AMENDMENTS <br />INCOMPLETE APPLICATION: <br />DATE DUE: <br />Part 1. GENERAL INFORMATION <br />A. ENFORCEMENT AGENCY: <br />B. COUNTY: <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />SAN JOAQUIN COUNTY <br />C. TYPE OF APPLICATION (Check one box only): <br />❑ 1, NEW SWFP and/or WDRS <br />F-14. PERMIT REVIEW <br />F-12, REVISION OF SWFP and/or WDRS <br />R5. AMENDMENT OF APPLICATION <br />113. EXEMPTION and/or WAIVER <br />R6. 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 />17720 East Harney Lane, Lodi Ca 94240 <br />2. LATITUDE AND LONGITUDE: <br />Latiitude:38 Degrees, 06 Minutes Longitude:121 degrees, 04 minutes <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 />®1. DISPOSAL <br />a. TYPE <br />[:]2. COMPOSTING <br />a. TYPE: <br />Class III <br />r73. TRANSFORMATION ®5. OTHER (describe): <br />®4. TRANSFER/PROCESSING FACILITY <br />❑ CHECK HERE IF RECYCLABLE MATERIALS ARE RECOVERED PRIOR TO TRANSFER/PROCESSING. <br />D. CONFORMANCE FINDING INFORMATION (CIWMP): <br />Fi1. FACILITY IS IDENTIFIED IN (Check one): <br />SITING ELEMENT <br />ONONDISPOSAL FACILITY EL <br />DATE OF DOCUMENT Apr -96 <br />DATE OF DOCUMENT <br />02. 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 <br />�2. ASBESTOS 0 Friable 17 Non -friable <br />�3.ASH <br />M4. AUTO SHREDDER <br />F-15. COMPOSTABLE MATERIAL (describe): <br />M6. CONSTRUCTION/DEMOLITION <br />M7. CONTAMINATED SOILS <br />Ms. DEAD ANIMALS <br />®9. INDUSTRIAL <br />M10. INERT <br />❑11. LIQUIDS <br />x12. MIXED/MUNICIPALSOLID WASTE <br />M13. SEWAGE SLUDGE <br />M 14. TIRES <br />®15. OTHER (describe): <br />PAGE# 18 <br />PAGE # <br />Page 1 <br />