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SOLID VVASTE FACILITY PJ 01 APPLICATION <br /> LRe '.'R r-1-17 ('r 71) <br /> r­Ct 'ACN-f AGENCY FOR ENFORCEMENT AGENCY USE ONLY <br /> (PERMIT NUMBER) <br /> San- Joaquin.-Local - a h. Di_stri_ol_ FILE NLmHER <br /> SanJ_oaau_in_Q.o.unjy_ DATE RECEIVED FILING FEE <br /> TYPE OF APPLICATION <br /> 2. APPLICATIONE ACCEPTED RECEIPT NUMBER <br /> Xj,_ NOTICE OF <br /> FAC L 'YID WASTE [j 1. APPLICATION FOR MODIFICATION <br /> OPERATION Il PERMIT f <br /> OF PERMIT I <br /> A. AMENDMENT DATE-PERMIT-ISSUED CO SWMP REFERENCE _FAGF:r.T <br /> OF <br /> APPLICATION 5. APPLICATION FOR REV... <br /> NOTE: This form has been developed for multiple uses. It is the transmittal sheet for documents required <br /> to be submitted to the enforcement agency, *A Report of Station or Disposal Site Information <br /> or an amendment thereto must be submitted with this form. <br /> [NAME OF FACILITY <br /> Forward, Inc. <br /> LOCATION OF FACILITY GIVE ADDRE55 OR LOCATION DE5CRIPTIDN BY SECTION. TC-NS"IP. RANGE. COUNTY Y <br /> Austin Road.--between Mariposa Road & Lynch Road R.7.E. ,TI .N. ,Sec. 10 <br /> TYPE OF FACILITY <br /> ® SOLID WASTE DISPOSAL SITE TRANSFERIPROCESSING STATION (INCLUDES RESOURCE RECOVERY) <br /> GENERAL <br /> ITYPE OF WASTES TO BE RECEIVED <br /> DESCRIPTION ; Or <br /> I 1X_ CRESIDENTIAL REFUSE t Aj CONSTRUCTION/DEMOLITION KASTES LAJ HAZARDOUS %vAsTes <br /> OF <br /> FACILITY AGRICULTURAL WASTES <br /> CO..E.CIAL SOLID WASTE. [�X] rE-. SLUDGE.G,. [_Aj <br /> 11111 <br /> FV TIP.ES I VJ(i LIQUIDS/SLUR R IES SEPTIC TANK PUMPING. <br /> OTHER <br /> -_ - ____ __ - - --— ___ - I---i I--F—F <br /> II OPERATION I EFFECTIVE PROPOSED CHANGE: (CHECK ONE OR BOTH DATE <br /> FAQ <br /> IN F �'.A�jct" D1:172 <br /> j CCM MEA CED WILL COMMENCE I DESIGN OPERATION <br /> LA <br /> OWNER OF PROPE_-T_Y_TNAM1EyI ADDRESS <br /> Forte -'.--,P.O_._ -Box 6336 Sto-c-k-t-on,Ca- - q_5n__6____ <br /> FOPERATOR NAME ADDRESS <br /> OPERATOR <br /> INFORMATION i __Forward.,_.__Inc,._ P.O. Box 6336-Stockton, Ca -952-0-6--- <br /> ADDRESS WHERE LEGAL NOTICE MAY BE SERVED <br /> C . _95206 <br /> FILING FEE ENCLOSED <br /> — <br /> BV. <br /> I hereby acknowledge that I have read this application and the Report of Station or Disposal Site Informa- <br /> tion, and certify that the information given is true and accurate to the best of my knowledge and belief. <br /> In operating the solid waste facility, I agree to comply with the conditions of the permit and with state <br /> and local enactments. <br /> SIGNATUR (OWNERTURE (OPERATOR ?R APJ�Nfl_ <br /> C NAME PED N NA E <br /> an J. ,a 0 Gregory J. Bas o <br /> TITLE � DATE TITLE DATE . <br /> President t8-11477 Vice President <br /> 1- 7- <br /> CHECK APPROPRIATE- - - * BOX- A 8711-7 <br /> ENFORCEMENTI 0 <br /> APPLICATION APPROVED APPLICATION DENIED <br /> AGENCY ir______________ <br /> ! SIGNATURETITLAN. 111�TID --li AND TELEPHONE NO. <br /> USE ONLY i ] E: <br /> OA717 1,F.CE.IVED CHECK APPROPRIATE III <br /> SOLID <br /> CONCUR W.T OE11:C7 TO <br /> H ..INC' 111:111AL UPHELD <br /> WASTE PROPOSED PERMIT PROPOSED PERMIT <br /> MANAGEMENT <br /> FOARD T.ER_j.PFC.Fyj___ <br /> 5 NAT URE <br /> USE CN LY TITLE AND PRINTED NAME DATE: AND TELEFICIL E.O. <br /> > A <br />