Form 98 - Standardized Nonhazardous Ash Solid Waste Facility Permit

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State of California
California Integrated Waste
CIWMB FORM 98 (new 7/96)
Management Board
STANDARDIZED NONHAZARDOUS ASH SOLID WASTE FACILITY PERMIT
1. Facility/Permit Number (SWIS):
2. Facility Name and Address/Location:
3. Operator Name and Mailing Address:
4. Owner Name and Mailing Address:
5. Enforcement Agency and Address:
6. Signature of Enforcement Agency Approving Officer:
8. Date Signed:
7. Please Print or Type Name and Title of Approving Officer:
9. Date Received by CIWMB:
10. CIWMB Concurrence Date:
11. Signature of CIWMB Approving Officer:
13. Date Signed:
12. Please Print or Type Name and Title of Approving Officer:
14. Date of Permit Issuance:
15. Permit Review Due Date:
The facility for which this permit has been issued shall only be operated in accordance with the description provided in the
application pursuant to Section 18105.1 and Report of Nonhazardous Ash Disposal Site Information pursuant to Section 18226.
(Applicants may use the Standardized Permit Application CIWMB 92).
16. Legal Description of Facility: (Description may be attached)

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