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v <br />STATE OF CALIFORNIA <br />CALIFORNIA INTEGRATED WASTE MANAGEMENT BOARD <br />REGIONAL WATER QUALITY CONTROL BOARD <br />APPLICATION FOR SOLID WASTE FACILITY PERIT/WASTE DISCHARGE REQUIREMENTS <br />CIWMB E -1 -47 -(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 />DATE ACCEPTED: <br />DATE REJECTED: <br />ACCEPTANCE DATE OF <br />INCOMPLETE APPLICATION: <br />DATE DUE: <br />Part 1. GENERAL INFORMATION <br />A. ENFORCEMENT AGENCY: <br />one <br />® 1. NEW SWFP and/or WDRS <br />02. REVISION OF SWFP and/or WDRS <br />B. COUNTY: <br />04. PERMIT REVIEW <br />®5. AMENDMENT OF APPLICATION <br />®3. EXEMPTION and/or WAIVER ®6. RFI/ROWD/JTD AMENDMENTS <br />Part 2. FACILITY DESCRIPTION <br />OF FACILITY: <br />B. LOCATION OF FACILITY: <br />1. PHYSICAL ADDRESS OR LOCATION AND ZIP CODE: <br />2. LATITUDE AND LONGITUDE: <br />3. LEGAL DESCRIPTION OF PERMITTED BOUNDARY BY SECTION, TOWNSHIP, RANGE, BASE, AND MERIDIAN, IF SURVEYED: <br />C. TYPE OF ACTIVITY: (Check applicable boxes): <br />®1. DISPOSAL E-13. TRANSFORMATION ®5. OTHER (describe): <br />a. TYPE: <br />M2. COMPOSTING <br />a. TYPE: <br />®4. TRANSFERIPROCESSING FACILITY <br />❑ 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 <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 />®1. AGRICULTURAL <br />El 2. ASBESTOS ❑ Friable O Non -friable <br />®3. ASH <br />®4. AUTO SHREDDER <br />E-15. COMPOSTABLE MATERIAL (describe): <br />1:16. CONSTRUCTION/DEMOLITION <br />E-17. CONTAMINATED SOILS <br />®8. DEAD ANIMALS <br />®9. INDUSTRIAL <br />010. INERT <br />®11. LIQUIDS <br />El 12. MIXED/MUNICIPAL SOLID WASTE <br />r-113. SEWAGE SLUDGE <br />®14. TIRES <br />15. OTH E R (describe): <br />PAGE # <br />PAGE # <br />Page 1 <br />