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APPENDIX C <br />N'TATE OF CALIFORNIA <br />RIEGIONAL WATER -�-Q--�U-�A-L=ITY-�--CONTROL 6 D. 47 <br />DEPARTMENT OF HEALTH SERVICES <br />SOLID WASTE MANAGEMENT BOARD <br />tEPARTMENT OF FORESTRY <br />-W top COOK <br />ZOP"KIIII W"*Wi CiiiQA� *a SGftV9O <br />Clerk he <br />--gf ulie -222 East Weber Q&tM. CA 95202 <br />REASON FOR FILING <br />A. New discharge or facility D. MX Change in character of discharge G. FJKJ Change i n business operating facility <br />B. Existing 400CX46lWacility E. <br />of <br />Change in place or method of disposal H. F-1 Enlargement <br />� existing facility <br />C, increase in quantity of)6tW]M F. Change in design or operation Other (explain below) <br />waste Di <br />;,gision o <br />aamersbi 9rWZcXe- <br />fit. TYPE OF OPERATION <br />A.: <br />Transferstation 0. Sews" treatment all"'Ill w# •: t <br />Solid waste disposal site <br />Industry (discharge to sewer) <br />IV. TYPE OF WASTE <br />Sewage, sewapi <br />seli tank pumpings <br />Industrial wastes <br />Municipal solid wastes <br />Hazardous wastes <br />H Other explain below) <br />Minicipal and <br />ccimmercial wastes <br />A1,11iii wastes 1. 1 Inert maitaria57- <br />r <br />F. Animal wastes J. Dead animals <br />G 181 <br />G. Frest product wastes K. ' Tires <br />in <br />H. o <br />Construction/demolition wastes wgj" <br />V. SITE DESIGN CAPACITY <br />V r —OP 'CA- -V —^C & T* V YI. ORBtON PfiRpI4ATiOM ON ti i.TpMAT�Lira axpeii <br />IF: <br />OR" zoo (Rii 5/40) (OVER) <br />I1I !!!!I! <br />Arrl-ILOA I 1-1 <br />FACILITY PERMIT/WASTE DISCHARGE <br />This form is to be used for filing a/an: (check all appropriate) <br />FO� OFFICE USE ONLY <br />1. REPORT OF WASTE DISCHARGE <br />Form 200 Rec'd <br />(pursuant to Division 7 of the State Water Code) <br />APPLICATION FOR A HAZARDOUS FACILITY PERMIT <br />WASTE <br />Fee (RWQCB) (SWMB) <br />Letter to Discharger <br />(pursuant to Health and Safety Code Section 25200) <br />!1 <br />i Report Rec'd <br />3. [XI APPLICATION FOR A SOLID WASTE FACILITIES PERMIT <br />(pursuant to Government Code Section 66796.30) <br />4. APPLICATION FOR A RUBBISH DUMP PERMIT <br />Effective Date <br />DF Notified <br />(pursuant to Public Resources Code Sections 4371-4375 and 4438) <br />DOHS No. <br />1. FACILITY <br />------------- <br />Sa <br />A JgAgMin <br />209 944-3211 <br />IC <br />ACOkWSS <br />XIP CODE <br />N ML OUSINESS OPERATING FACILITY <br />%n J in QQpn <br />2Q9 944-2aal- <br />L <br />^DDRILSS <br />ZIP COOK <br />1810 East Haze1ton.AVql%leI 9tQ9ktQ <br />0. Tiir' OF BUSIN11i OPURATING FACILITY <br />Sole Proprietorship Partnership Corporation <br />Government Agency <br />11i NAMi OF —0WV19—ftTjT-45-F-j—Uj-jjjkj PERATING FACILITY <br />'a, ONK 0 <br />IT <br />San JoaQuin Countv <br />M*"Q OAA -11 A <br />-W top COOK <br />ZOP"KIIII W"*Wi CiiiQA� *a SGftV9O <br />Clerk he <br />--gf ulie -222 East Weber Q&tM. CA 95202 <br />REASON FOR FILING <br />A. New discharge or facility D. MX Change in character of discharge G. FJKJ Change i n business operating facility <br />B. Existing 400CX46lWacility E. <br />of <br />Change in place or method of disposal H. F-1 Enlargement <br />� existing facility <br />C, increase in quantity of)6tW]M F. Change in design or operation Other (explain below) <br />waste Di <br />;,gision o <br />aamersbi 9rWZcXe- <br />fit. TYPE OF OPERATION <br />A.: <br />Transferstation 0. Sews" treatment all"'Ill w# •: t <br />Solid waste disposal site <br />Industry (discharge to sewer) <br />IV. TYPE OF WASTE <br />Sewage, sewapi <br />seli tank pumpings <br />Industrial wastes <br />Municipal solid wastes <br />Hazardous wastes <br />H Other explain below) <br />Minicipal and <br />ccimmercial wastes <br />A1,11iii wastes 1. 1 Inert maitaria57- <br />r <br />F. Animal wastes J. Dead animals <br />G 181 <br />G. Frest product wastes K. ' Tires <br />in <br />H. o <br />Construction/demolition wastes wgj" <br />V. SITE DESIGN CAPACITY <br />V r —OP 'CA- -V —^C & T* V YI. ORBtON PfiRpI4ATiOM ON ti i.TpMAT�Lira axpeii <br />IF: <br />OR" zoo (Rii 5/40) (OVER) <br />