Stanislaus County

Department of Environmental Resources

1 Name of applicant: Phone:

2. Permanent home, business and full local addressees):

3. Trade and firm name:

4. If a joint venture, a partnership, or limited partnership, the names of all partners and their percentage of participation and their permanent addresses:

5. If a corporation, the names and permanent addresses of all stockholders and the officers and the percentage of participation of each:

6. Explain the manner in which you operate your resource recovery/recycling activity including the types of equipment used and how used in the recycling activity. Indicate whether satellite centers involved.

7. Where (location) are recover/recycled materials processed and stored?

8. Does your business operate a drop box system (where materials are received) and if so, how many drop boxes do you have and where are they located?

9. Do you receive recovery/recycled materials from other counties? In what volumes and where received from?

10. How many employees do you have? (Permanent and Temporary)

11. Do you plan any extensive changes in your operation in the near future (expansion of activities, equipment changes, move to new location, etc.)?

12. Do you operate seasonally or year round?

13. Indicate estimated quantities processed for each waste category.

14. List all markets which you currently sell your recovered materials to. Identify materials sold to each market.

15. List each recovered material for which there is no market. Is material stored or disposed of? Indicate quantities.

I AGREE TO COMPLY WITH ALL PROVISIONS OF THE STANISLAUS COUNTY REFUSE ORDINANCE #476 AND I CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION, STATEMENTS, AND REPRESENTATIONS SET FORTH IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT.

DATED

BY

 FIRM (SIGNATURE)

ADDRESS (TITLE)

FORM,2OOO 1-93513+25

C;\WP60\SWFORMS\FORM2000.