Laserfiche WebLink
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. 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 -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 />03. EXEMPTION and/or WAIVER <br />06. 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 />FX14. PERMIT REVIEW <br />❑2. REVISION OF SWFP and/or WDRS <br />❑5. AMENDMENT OF APPLICATION <br />03. EXEMPTION and/or WAIVER <br />06. RFI/ROWD/JTD AMENDMENTS <br />Part 2. FACILITY DESCRIPTION <br />A. NAME OF FACILITY: <br />North County Landfill <br />B. LOCATION OF FACILITY: <br />1. PHYSICAL ADDRESS OR LOCATION AND ZIP CODE: <br />17900 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 F-13. TRANSFORMATION ED& OTHER (describe): <br />a. TYPE: Class III <br />72. COMPOSTING E74. TRANSFER/PROCESSING FACILITY <br />a. TYPE: ❑ CHECK HERE IF RECYCLABLE MATERIALS ARE RECOVERED PRIOR TO TRANSFER/PROCESSING. <br />D. CONFORMANCE FINDING INFORMATION (CIWMP): <br />FX -11. FACILITY IS IDENTIFIED IN (Check one): <br />ED SITING ELEMENT DATE OF DOCUMENT Apr -96 PAGE # 18 <br />EDNONDISPOSAL FACILITY EL DATE OF DOCUMENT PAGE # <br />72. 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 FX -16. CONSTRUCTION/DEMOLITION F-�11. LIQUIDS <br />M2. ASBESTOS ❑ Friable O Non -friable E-17. CONTAMINATED SOILS fxx-�12. MIXED/MUNICIPAL SOLID WASTE <br />F73. ASH F-18. DEAD ANIMALS 713. SEWAGE SLUDGE <br />74. AUTO SHREDDER Fx -19. INDUSTRIAL [714. TIRES <br />F-110. INERT [715. OTHER (describe): Household hazardous <br />Fx -15. COMPOSTABLE MATERIAL (describe): <br />Page 1 <br />