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STATE OF CALIFORNIA CALIFORNIA INTEGRATE"WASTE MANAGEMENT BOARD <br /> SOLID,WASTE FACILITIES PERM 'LIGATION <br /> CIWMB E-1.77 tRLV.0/921 ILI <br /> ENFORCEMENT AGENCY: Environmental FOR ENFORCEMENT AGENCY US Y <br /> Public Health Services , Health Division FILE NUMBER(PERMIT NUMBER) <br /> COUNTY: <br /> FINE <br /> PE <br /> San Joa uin TYPE OF APPLICATION: 07, <br /> OUNTYWID®1. NEW SOLID WASTE FACILITY PERMIT ®,.MODIFICATION Of:PERMIT ❑7.AMENDMENT OF APPLICATION ENCE PAGE(Sl:2. REVISION OF PERMIT ®5. EXEMPTION FROM PERMIT ENVIR HEALTH <br /> PE <br /> ®3. PERMIT REVIEW ®e. FACILITY CLOSURE <br /> NOTE:This form hes been developed for multiple uses. It is the transmittal shoot for documents required to be submitted to the <br /> local enforcement agency. See Instructions for completing this application. <br /> L GENERAL NAME OF FACILITY: r+ <br /> DESCRIPTION LOCATION OF FACILITY: (GIve address or location, also Include legal doscriptlon by section,township,range,baso,and <br /> OF moddlon It surveyed or projected. Section 3 , T1S, R7E MDBM; 9999 S. Austin R. ,Mantecz <br /> FACILITY <br /> TYPE OF FACILITY: LANDFILL ®PROCESSING FACILITY ®MATERIAL RECOVERY FACILITY <br /> ®SUMP OTRANSFER STATION ®LAND SPREADING <br /> ®TRANSFORMATION ®COMPOSTING <br /> FACILITY IMIXED WASTES) <br /> TYPE OF WASTES TO BE RECEIVED: <br /> AGRICULTURAL DEAD ANIMALS ❑Ts <br /> IgASSESTOS IOUSTRIAL OWOOD MILL <br /> ASH 'f;"JIIQUl03(INCLUDE'SEPTAGEIOTHEft DESIGNATED WASTE <br /> ID <br /> AUTO SHREDDER MIXED MUNICIPAL ®OTHERHAZ�1RDOtJsee the <br /> CONSTRUCTION/DEMOLITTON thwSLUDGE r OTHER:tDESCRM RDS I <br /> 11. FACILITY PROPOSED CHANGE EFFECTIVE DATE <br /> INFORMATION COMMENCED ICHECK APPUCAaLI 111OXE01 OF PROPOSED CHANGE: <br /> Date: mxrDESIGN <br /> ®Will COMMENCE ®NO CHANGE <br /> Oats: <br /> 1 18 5 6 0 0 [g]oPERATTON <br /> AVERAGE ANNUAL PEAK DAILY 4 ,180 FACILITY �SIN <br /> ITE CAPACITY EXPECTED CLOSURE DATE: <br /> LOADINO(TM: LOADINO(TP01: SIZE IAI: YARDS: 13 $ �# 000 <br /> III. OPERATOR OWNER OF LAND ADDRESS: TELEPHONE NUMBER: <br /> INFORMATION (Name►: <br /> For land disposal, <br /> H operator Is FACILITY OPOIA OR ADDRESS: <br /> dNhrsnt from (Name), <br /> land owner,attach <br /> lease or tranchlso ADDRESS WHER ED:LEGAL NOTICE MAY BE SERVTE7LEPHON fi <br /> agraertrsM. <br /> 1 hereby acknowledge that i have rood this application and the Report of Facility Information, and certify that the Informedon given Is <br /> true and accurate to the best of my knowledge and belief. In operating the solid waste facility. I agree to Comply with the conditions <br /> of the permit and with federal, stets, and local enactments. <br /> SIGNATURE 4,AND OWNER ORI ENT)'`> SIGNATURI`FA ILITY OPERATO ADEN : T <br /> TYPED NAME: <br /> TYPED NAME: <br /> "— <br /> TITLE: DATE. <br /> TITLE: OATS: XT4 Q2--AErxgl am'L <br /> W.LIST OF ATTACHMENTS ICHECK IF APPLICABLEI: <br /> ®REPORT OF FACILITY INFORMATION ®SWAT(AIR AND WATER( <br /> ®PERIODIC SITE REVIEW ®STORMWATER DISCHARGE PERMITS(NPOES) <br /> ®LOCAL USEIPLANNING PERMITS aWETIANDS PERMIT <br /> ®OPERATING LIABILITY FINANCIAL MECHANISM ®PRELIMINARY CLOSUREIPOSTCLOSURE MAINTENANCE PLAN <br /> ®DEPARTMENT OF HEALTH SERVICES PERMIT ®FINAL CLOSUREIPOSTCLOSURE MAINENANCE PLAN <br /> ®AIR QUALITY/POLLUTION CONTROL DISTRICT PERMITS ®FINANCIAL RESPONSIBILITY DOCUMENTATION <br /> CERTIFIEO ENVIRONMENTAL REVIEW REPORTS ICEQAI ®OTHER REGULATORY AGENCY PERMITS <br /> ®WASTE DISCHARGE REQUIREMENTS OTHER <br /> WEAMITALS41921 <br /> a <br />