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C(DPY.::lt <br /> STATE OF CALIFORNIA CALIFORNIA INTEGRATED WASTE NIANAGEMENT BOARD <br /> CIW"4B-605 (NE',i is 97) <br /> LEA APPLICATION FOR ASBESTOS CONTAINING WASTE PROGR.: M AUTHORIZATION <br /> FOR AGENCY :SE ONLY: <br /> Received by Depury Director <br /> Reviewed by LEA Branch <br /> Reviewed by Permics Branch <br /> Reviewed by Enforcement Branch <br /> Reviewed by Health and Safety Branch <br /> LEA Jurisdiction SAN JOAQUIN COUNTYContact PersonGREG OLIVEIRA Phone(209) 468-0341 <br /> List the facility(s) (per 14 CCR 17897.10) in your jurisdiction currently disposing of or intending to dispose of <br /> asbestos containing waste (ACW). Include site name and SWIS number. <br /> FORWARD LANDFILL 39-AA-0015 <br /> Type of Authorization Requested (Please check applicable box.) <br /> .� Provisional Authorizarion—LEA meets requirements per 14 CCR 17897.25 (a) (1) and (2) and requests <br /> authorization to enforce sections 17897.15 - .16, and 17897.19(a-c) only. <br /> 1) Applicant is a certified Local Enforcement Agency. <br /> 2) LEA Director certifies by signing below that field staff have been provided training per 14 CCR 17897.25(x)(2) and the <br /> Illness. Injury Prevention Plan has been amended in compliance with Title 8. <br /> Full Authorization—LEA meets requirements per 14 CCR 17897.25 (a)(1-5), and requests authorization to <br /> enforce the complete Chapter 3.5 Articles 1-4. <br /> l) Applicant is a certified Local Enforcement Agency <br /> 2) LEA Director certifies by signing below that field staff have been provided training per 14 CCR 17897.25(a)(2)and the <br /> Illness, Injury Prevention Plan has been amended in compliance with Title S. <br /> 3) Attached are amended components of the Enforcement Program Plan(EPP)addressing the elements modified as a result of <br /> this authorization.(i.e. EPP components 2, 6, 7, 10,and 12). <br /> -) LEA Director certifies that field staff has been provided training per 14 CCR 1789725(a)(4). <br /> 5) LEA Director certifies that field staff has been provided the necessary personal protective equipment to comply with this <br /> authorization. <br /> ..� i nis agency is not requesting authorization at this time and understands the enforcement responsibilities for <br /> Title 14, Division 7, Chapter 3.5 will default to the CIWivfB. <br /> r'nder penalty of perjury, all information submitted for C1WMB consideration for LEA enforcement of the <br /> .asbestos Containing Waste program is, to the best of my knowledge and belief, true and correct. <br /> .:.A Program Director DONNA HERAN 99 <br /> Signature de Date —.2� <br /> Please mail this appiication with any supporting documentation to the Deputy Director, Permitting and Enforcement Division, 8800 <br /> Cal Canter Drive. Sacramento CA 9586. <br />