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State of California *Department of Resources Recycling and Recovery (CalRecycle) Standardized Permit Application Ca [Recycle 92 (Revised 10/16) Facility Name: i/err J Rocsb Facility Address (include street, P.O. box, city, state, ZIP code): /6551 J�e.,P� R b EScvlo>ti (40 U-3ev FacilityOperator '5Name: Operator's Address (include street, F.O. box, city, state, ZIP code): Land Owner's Name (if different from operator): mw 4Sr l✓�k Land Owner's Address (include street, P.O. box, city, state, ZIP code): /'8/73 5J"er'neyu if Ra Affsoolon A?57 CJ Facility Information CaiRecycle0 See instructions on back Facilityphone number: (zoq ) 679�175_C Operator's phone number:.( Land Owner's phone nwnber:� California Code of Regulations section number authorizing eligibility: Type of waste material(s) handled (please be specific): , Volume of waste material(s) handled. Site Capacity: Cubic yards I Daily peak loadinf.,ft14WLCubicyards � Annual loading: Cubic yards Days and hours of operation: 7: 6> f-4+^" — C(; w 1o''ri Facilitysize: tro Moacres I Operating area size: acres Incoming waste material (number of vehicles per day): /'p Outgoing waste material (number of vehicles per day): j One of the following statements must be checked: Q Issuance of the permit will not prevent or substantially impair achievement of the diversion goals of the jurisdiction from which it received solid waste; the facility is identified and described in or conforms with the county solid inanagement waste plan, or otherwise complies with Public Resources Code 50000; The facility is consistent with the city or county general plan and is compatible with surrounding land uses, or otherwise complies with Public Resources Code 50000.1. ❑ The facility is identified in either the countywide siting element, the nondisposal facility element, or in the source reduction and recycling element for the jurisdictions in which it is located; or, that the facility is not required to be identified in any of these elements pursuant to section 50001 of the public resources code. This application must be accompanied by a: ❑Report of facility information, ❑ Site plan, ❑ Location map, and eithhr ❑ Evidence of compliance with CECIA, or ❑ Information on the status of CEQA Certification I hereby acknowledge that I have read this application, and certify under penalty of perjury that the information provided is true and accurate. In operating the facility, agree to comply with the conditions of the permit, and with federal, state and local requirements and enactments. Land owner's signature:U�PiUU Date signedr Operator's signature: 6ert �ytaz Enforcement Agency Name and Address: 0' For Enforcement Agency Use Only Date Received: Date Approved: Date Rejected: Date signed: V Z /' Filing Fee: SWIS #: