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STATE OF CALIFORNIA <br />CALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD <br />REGIONP'+�W,ATER QUALITY CONTROL BOARD <br />APPLICATION FOR SOLID WASTE FACILITY PERMIT/WASTE DISCHARGE REQUIREMENTS <br />4 <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 />39 -AA -0022 <br />DATE ACCEPTED: <br />DATE REJECTED; <br />ACCEPTANCE DATE OF <br />INCOMPLETE <br />�� <br />APPLICATION: <br />DATE DUE: <br />Part 1. GENERAL INFORMATION <br />A. ENFORCEMENT AGENCY: B. COUNTY: <br />Environmental Health Department San Joaquin County <br />C. TYPE OF APPLICATION (Check one box only): <br />D 1. NEW SWFP and/or WDRS 04. PERMIT REVIEW <br />®2. REVISION OF SWFP and/or WDRS 05. AMENDMENT OF APPLICATION <br />11 3. 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 />17720 East Harney Lane, Lodi, CA 94240 (nearest cross street = Atkins Road) <br />2. LATITUDE AND LONGITUDE: <br />Latitude 38 deg 06 min, Longitude 121 deg 04 min <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 />02. COMPOSTING <br />a. TYPE: <br />Class III <br />E-13. TRANSFORMATION <br />®5.OTHER (describe): Recovery of recycleable materials prior to disposal <br />Processing green wase prior o remova <br />®4. TRANSFER/PROCESSING FACILITY (Processing) <br />X 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 />ONONDISPOSAL FACILITY EL <br />DATE OF DOCUMENT April 1996 <br />DATE OF DOCUMENT <br />R2. 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 ®6. CONSTRUCTION/DEMOLITION F-111. LIQUIDS <br />M2. ASBESTOS o Friable o Non -friable 07. CONTAMINATED SOILS ®12. MIXED/MUNICIPAL SOLID WASTE <br />F-13. ASH ®8. DEAD ANIMALS F-113. SEWAGE SLUDGE <br />PAGE # 18 <br />PAGE # <br />1:34. AUTO SHREDDER ®9. INDUSTRIAL ®14. TIRES <br />®10. INERT ®15. OTHER (describe): HHW, paint, wood waste and yard clippings, <br />other items as described in JTD. <br />®5. COMPOSTABLE MATERIAL (describe): Green waste and discarded lumber processed prior 0 remova <br />