APPENDIX A

PROCLAMATION OF A STATE OF EMERGENCY

GOVERNOR BROWN DIRECTS ASSISTANCE FOR MONO COUNTY WILDFIRE

2-26-2015

A PROCLAMATION OF A STATE OF EMERGENCY WHEREAS a fire started on February 6, 2015, in Mono County; and WHEREAS the fire burned thousands of acres, destroying over 40 structures, including residences, necessitating the evacuation of residents and the opening of emergency shelters; and WHEREAS the fire created a substantial amount of hazardous debris over a large area, affecting the community of Small Meadows; and WHEREAS this debris is threatening public health and safety and the environment, and it must be removed and disposed of quickly and properly to ensure that the area can be reoccupied safely; and WHEREAS on February 6, 2015, Mono County proclaimed a local emergency declaring that conditions of extreme peril to the safety of persons and property exists, and on February 11, 2015, the Mono County Health Officer declared a local health emergency due to hazardous debris from this fire; and WHEREAS the circumstances of this fire, by reason of their magnitude, are or are likely to be beyond the control of the services, personnel, equipment and facilities of any single local government and require the combined forces of a mutual aid region or regions to combat; and WHEREAS under the provisions of sections 8567 and 8571 of the Government Code, I find that strict compliance with the various statutes and regulations specified in this Proclamation would prevent, hinder, or delay the mitigation of the effects of the fire; and WHEREAS under the provisions of section 8558(b) of the California Government Code, I find that conditions of extreme peril to the safety of persons and property exists within Mono County due to this fire. NOW, THEREFORE, I, EDMUND G. BROWN JR., Governor of the State of California, in accordance with the authority vested in me by the State Constitution and statutes, including the California Emergency Services Act, and in particular, section 8625 of the California Government Code, HEREBY PROCLAIM A STATE OF EMERGENCY to exist within Mono County. IT IS HEREBY ORDERED THAT: 1. All agencies of the state government utilize and employ state personnel, equipment, and facilities for the performance of any and all activities related to this state of emergency consistent with the direction of the Office of Emergency Services and the State Emergency Plan. 2. The Office of Emergency Services shall provide local government assistance, as appropriate, under the authority of the California Disaster Assistance Act, California Government Code section 8680 et seq. and California Code of Regulations, Title 19, section 2900 et seq. 3. State statutes, rules, regulations, and requirements are hereby suspended to the extent they apply to the following activities: (a) removal, storage, transportation, and disposal of hazardous and non-hazardous solid waste and debris resulting from the fire that has burned in Mono County and that are subject to the jurisdiction of agencies within the California Environmental Protection Agency and the California Natural Resources Agency; and (b) necessary restoration and rehabilitation of timberland, streams, rivers, and other waterways. Such statutes, rules, regulations, and requirements are hereby suspended only to the extent necessary for expediting the removal and cleanup of debris from the fire and for implementing any restoration plan by Mono County. Individuals who desire to conduct activities under this suspension of statutes, rules, regulations, and

requirements shall first request that the appropriate Agency Secretary, or that Agency Secretary's delegate, make a determination that the proposed activities are eligible to be conducted under this suspension. 4. The Secretary for the California Environmental Protection Agency and the Secretary for the California Natural Resources Agency shall use sound discretion in applying this order to ensure that the suspension serves the purpose of accelerating cleanup and recovery, while at the same time protecting public health and the environment. This order shall apply to, but is not necessarily limited to: solid waste facility permits, waste discharge requirements for storage and disposal; emergency timber harvesting; emergency construction activities; and waste discharge requirements and/or Water Quality Certification for discharges of fill material or pollutants. To the extent it is within their administrative authority, the boards, departments, and offices within the California Environmental Protection Agency and the California Natural Resources Agency shall expedite the granting of other authorizations, waivers, or permits necessary for the removal, storage, transportation, and disposal of hazardous and non-hazardous debris resulting from the fire and for other actions necessary for the protection of public health and the environment. 5. As necessary to assist local governments and for the protection of public health and the environment, state agencies shall enter into contracts to arrange for the procurement of materials, goods, and services necessary to quickly remove dangerous debris and repair damaged resources. Because strict compliance with the provisions of the Government Code and the Public Contract Code applicable to state contracts would prevent, hinder, or delay these efforts, applicable provisions of those statutes, including but not limited to travel, advertising, and competitive bidding requirements are suspended to the extent necessary to address the effects of the fire. 6. State agencies and departments within my administration shall work with local officials to assist them in establishing and implementing a comprehensive debris removal plan. This Proclamation is not intended to, and does not, create any rights or benefits, substantive or procedural, enforceable at law or in equity, against the State of California, its agencies, departments, entities, officers, employees, or any other person. I FURTHER DIRECT that as soon as hereafter possible, this Proclamation be filed in the Office of the Secretary of State and that widespread publicity and notice be given of this Proclamation. IN WITNESS WHEREOF I have hereunto set my hand and caused the Great Seal of the State of California to be affixed this 26th day of February 2015. ____________________________ EDMUND G. BROWN JR. Governor of California ATTEST: ________________________________ ALEX PADILLA Secretary of State

APPENDIX B

ROUND FIRE SWALL MEADOWS AND PARADISE VALLEY ADDRESSES

Address ST_Prefix Street ST_Suffix Community Mailing_St Mailing_Ci Mailing__1 Mailing_Zi9 Wilson Road Swall Meadows 9 WILSON RD BISHOP CA 93514 1 3/14/2015 Signed Up11 Wilson Road Swall Meadows 2 3/16/201545 Pine Drive Swall Meadows 45 PINE DRIVE SWALL MEADOWS, BISHOP CA 93514 3 Declined55 Pinon Drive Swall Meadows 55 PINON DR. SWALL MEADOWS, BISHOP CA 93514 4 3/16/2015 Rescinded ROE but may still sign up later.59 S Valley View Drive Swall Meadows 59 VALLEY VIEW RD. SWALL MEADOWS BISHOP CA 93514 567 N Valley View Drive Swall Meadows 3754 ROSE AVENUE LONG BEACH CA 90807 6 3/12/2015 Revisions List72 N Valley View Drive Swall Meadows 72 N. VALLEY VIEW SWALL MEADOWS, BISHOP CA 93514 7 3/12/2015 1. Created 3/12/201589 Wilson Road Swall Meadows 1125 N NOPAL STREET SANTA BARBARA CA 93103 8 2. Revised 3/16/201594 Mountain View Drive Swall Meadows 94 MOUNTAIN VIEW DR. SWALL MEADOWS BISHOP CA 93514 9 3/16/201597 S Valley View Drive Swall Meadows 97 S. VALLEY  VIEW SWALL MEADOWS CA 93514 10105 Sierra Wave Drive Swall Meadows 11 3/12/2015130 S Valley View Drive Swall Meadows 130 VALLEY VIEW ROAD SWALL MEADOWS CA 935147116 12140 Willow Road Swall Meadows 140 WILLOW RD. SWALL MEADOWS BISHOP CA 93514 13153 Foothill Road Swall Meadows 6543 MOORE DRIVE LOS ANGELES CA 90048 14 3/14/2015159 Willow Road Swall Meadows 159 WILLOW RD. SWALL MEADOWS BISHOP CA 93514 15 3/14/2015171 Pine Drive Swall Meadows P. O. BOX 91714 LONG BEACH CA 90809 16 3/16/2015 ROE mailed175 Foothill Road Swall Meadows 175 FOOTHILL RD SWALL MEADOWS CA 93514 17 3/12/2015193 Foothill Road Swall Meadows 193 FOOTHILL RD. SWALL MEADODWS, BISHOP CA 93514 18 3/12/2015255 Rimrock Drive Swall Meadows 641 N. BUCKBOARD LANE GLENDORA CA 91741 19 3/12/2015280 Pinon Drive Swall Meadows 1938 PINE STREET HUNTINGTON BEACH CA 92648‐2761 20 3/16/2015301 Rimrock Drive Swall Meadows 301 RIMROCK DRIVE BISHOP CA 93514 21 3/12/2015320 Mountain View Drive Swall Meadows 320 MOUNTAINVIEW DRIVE BISHOP CA 93514 22 3/16/2015330 Rimrock Drive Swall Meadows 23 3/12/2015346 S Valley View Drive Swall Meadows P.O. BOX 351 MAMMOTH LAKES CA 93546 24 3/12/2015370 Rimrock Drive Swall Meadows 1164 DEVONSHIRE DR. ENCINITAS CA 920245125 25460 Rimrock Drive Swall Meadows 1727 SHOSHONE DRIVE BISHOP CA 93514 26 3/16/2015461 Mountain View Drive Swall Meadows 27507 Willow Road Swall Meadows P.O. BOX 194 MAMMOTH LAKES CA 93546 28 3/16/2015519 Willow Road Swall Meadows 29 3/14/2015739 Mountain View Drive Swall Meadows 5820 OLD STONY WAY DURHAM NC 27705 30788 Mountain View Drive Swall Meadows 826 GARY AVENUE SUNNYVALE CA 94086 31818 Mountain View Drive Swall Meadows 2465 CAMINTO OCEAN COVE CARDIFF BY THE SEA CA 92007 32 3/16/2015826 Swall Meadows Road Swall Meadows 826 SWALL MEADOWS ROAD BISHOP CA 93514 33 3/12/2015926 Sky Meadows Road Swall Meadows 926 SKY MEADOW ROAD SWALL MEADOWS, BISHOP CA 93514 34931 Swall Meadows Road Swall Meadows 931 SWALL MEADOWS RD SWALL MEADOWS CA 93514 351046 Swall Meadows Road Swall Meadows PO BOX 8088 MAMMOTH LAKES CA 93546 361274 Swall Meadows Road Swall Meadows SWALL MEADOWS BISHOP CA 93514 37 3/12/20151430 Swall Meadows Road Swall Meadows PO BOX 1410 MAMMOTH LAKES CA 93546 381450 Swall Meadows Road Swall Meadows 1450 SWALL MEADOWS ROAD SWALL MEADOWS, BISHOP CA 93514 39 3/12/20154866 Deer Peak Trail Paradise Estates 4866 DEER PEAK TRAIL BISHOP CA 93514 40 3/12/2015

APPENDIX C

RIGHT-OF-ENTRY PERMIT

1

RIGHT OF ENTRY PERMIT

[For debris removal on private property]

I, ___________________________________ (Owner), hereby permit the County of Mono, its officers,

employees, agents, contractors and subcontractors (County), to enter the Owner’s property located at

__________________________ (Property), subject to all licenses, easements, encumbrances, and claims of title

affecting the Property upon the following terms and conditions:

1. Grant of Right-of-Entry. Owner hereby grants the County the right to enter the Property for the

purpose of inspecting, testing materials, or removing any wildfire-generated debris of whatever nature

including but not limited to ash, vehicles, trailers, miscellaneous debris, trees identified by an arborist as

hazardous, waste or other materials from the Property, subject to the terms and conditions set forth in

this Right-of-Entry Permit (Permit). It is fully understood that this Permit does not create any obligation

on the County to perform inspection, testing, or remove debris. Owner understands that the County will

undertake no cleanup action until this Permit is signed.

2. Private Insurance Coverage. Most homeowner insurance policies have coverage to pay for the costs

of removal of wildfire-generated debris. Owner understands that in the event state financial assistance

is received by the Owner for purposes of inspection, testing or removing debris hereunder, state law

(Title 19, Division 2. California Governor’s Office of Emergency Services, Chapter 6. Disaster

Assistance Act) requires the Owner to reimburse the County for the cost of removing wildfire-generated

debris to the extent covered in the Owner’s insurance policy. Owner also understands that, when

requested, Owner must provide a copy of the insurance policy, proof/statement of loss and settlement

agreement from Owner’s insurance company to the County.

Owner (_____ does, _____ does not) have homeowners or other similar insurance. If Owner indicates

that Owner does not have such insurance, Owner certifies under penalty of perjury that there was no

insurance in effect at the time of the wildfire which may provide coverage for the costs of inspection,

testing or removing debris.

3. Duplication of Benefits. Owner (_____ has, _____ has not) and (_____ will, _____ will not)

receive(d) any compensation for debris removal from any other source including Small Business

Administration individual and family grant program or any other public assistance program. Owner will

advise County in writing within 10 days of receipt of any insurance settlement for debris removal.

Owner further agrees to reimburse the County within 10 days of receipt of any insurance from such

insurance proceeds for the cost of the debris removal conducted by the County. In the event the

insurance proceeds are less than the cost of debris removal incurred by the County, the Owner will not

be responsible for the difference. If the insurance proceeds exceed the County’s costs of debris removal,

Owner will keep any excess proceeds. Owner understand that all disaster related funding, including that

for debris removal from private property, is subject to audit.

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4. Hold Harmless. County shall not be liable for, and Owner shall indemnify and hold harmless the

County, State of California, California Governor’s Office of Emergency Services (CalOES), California

Environmental Protection Agency (CalEPA), California Department of Resources Recycling and

Recovery (CalRecycle) and any of their officers, agencies, agents, contractors, subcontractors,

employees and volunteers, against any and all claims, deductibles, self-insured retentions, demands

liability, judgments, awards, fines, mechanics’ liens or other liens, labor disputes, losses, damages,

expenses, personal injury, chargers or costs of any kind or character, including attorneys’ fees and court

costs (hereinafter collectively referred to as “Claims”), which arise out of or are in any way connected to

actions arising out of this Permit, and hereby release, discharge and waive any claims and actions , in

law or equity, arising therefrom.

Owner shall make Owner’s best efforts to mark any sewer lines, utilities (electricity, gas, cable, etc.),

septic tanks, and water lines located on the Property.

5. No County Assumption of Liability for Remediation. In consideration of the assistance the County is

providing to the Owner under this Permit at no cost to the Owner, the County assumes no liability or

responsibility, and the Owner shall not seek to recover from the County, CalOES, CalEPA, CalRecycle,

or any of their officers, agencies, agents, contractors, subcontractors, employees and volunteers, the

costs of any remediation of damages to the Property incurred due to action taken pursuant to this Permit.

6. County Agents. Any person, firm, or corporation authorized to work on the Property by the County

shall be deemed to be a County agent, including but not limited to employees, agents, or representatives

of the State of California, CalOES, CalEPA, and CalRecycle, and shall be subject to all applicable terms

hereof.

7. Authority.

a. Owner is natural person or persons: Owner represents and warrants that it has full

power and authority to execute and perform its obligations under this Permit and that

fee title to the Property vests solely in the person or persons described above as

Owner.

b. Owner not a natural person: If the Owner is not a natural person (e.g., if Owner is a

corporation, trust, etc.), then this Permit must be executed by a duly authorized agent

of Owner having the full power and authority pursuant to Owner’s governing

documents to execute this Permit on behalf of the Owner, to bind Owner, and to

perform Owner’s obligations hereunder, without the need for any further action. The

person(s) executing this Permit on behalf of the Owner certify that they are the duly

designated agents of the Owner as described above, and that fee title to the Property

vests solely in Owner.

8. Entire Agreement. This Permit constitutes the entire agreement between the parties with respect to the

subject matter hereof, and all prior or contemporaneous agreements, understandings and representations,

oral or written, are superseded.

9. Modification. The provisions of this Permit may not be modified except by a written instrument signed

by both parties.

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10. Partial Invalidity. If any provisions of this Permit is determined by a court of competent jurisdiction to

be invalid or unenforceable, the remainder of this Permit shall not be affected thereby if this Permit’s

primary purpose(s) can be carried out. Each provision hereof shall be valid and enforceable to the

fullest extent permitted by law.

11. Successors and Assigns. This Permit shall bind and benefit the parties and their successors and

assigns, except as may otherwise be provided herein.

12. Notices. Any notice required hereunder shall be provided as follows:

For the County:

Sarah Messerlian

Mono County Risk Management

P.O. Box 696 Bridgeport, CA 93517

Phone number: 760.932.5405

Email: smesserlain@mono.ca.gov

For the Owner(s):

Name: ________________________________________

Address: ______________________________________

Phone: _______________________________________

Representative Capacity (if any): ___________________

IN WITNESS WHEREOF, Owner and County have executed this Permit effective as of ____________ (date).

COUNTY: OWNER(s):

County of Mono, ____________________________________

A political subdivision of the State of California Printed Name

By: ____________________________________

Signature

__________________________________

Jim Leddy, County Administrative Officer Phone (work): _______________________

Phone (mobile): ______________________

Phone (home): _______________________

Email: ______________________________

Please supply the following insurance information:

Insurance Company: ________________________________________________________________

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Policy Number: ____________________________________________________________________

Agent Name: ______________________________ Agent Phone Number: ____________________

Please check all that apply on the Property:

Large Item

Description

Quantity Keep Remove Instructions

Vehicles

Boats

Trailers

Trees1

Other:

1. Trees identified by a Certified Arborist as dead or dying are considered hazardous and will be cut down

and removed through this Permit. These trees constitute a hazard to the public health, safety, and

welfare. Tree stumps will not be removed.

Special Instructions (i.e. directions to contractors to access the Property or notable items Owner wishes to try

to recover):

APPENDIX D

CONTACT LIST AND INFORMATION

ROUND FIRE DEBRIS REMOVAL OPERATIONS CONTACT LIST

Name Team Title/Job Title Agency/Company Email Office Mobile

Alan Zamboanga Financial Chief CalRecycle Alan.Zamboanga@CalRecycle.ca.gov (916) 341‐6450 (916) 812‐2406

Bob Healy Logistics Chief CalRecycle Robert.Healy@CalRecycle.ca.gov (916) 341‐6132

Diane Nordstrom‐Lamkin Planning Chief CalRecycle Diane.Nordstrom‐Lamkin@calrecycle.ca.gov (916) 341‐6448 (916) 996‐9261 (DROC)

Glenn Inouye Water District Contact Wheeler Crest Community Service ghinouye1@gmail.com (760) 914‐0405

Jan Sudomier Air Quality Permitting Great Basin APCD jsudomier@gbuapcd.org (760) 872‐8211 ext. 227

Jeff Walters Public Works County of Mono jwalters@mono.ca.gov (760) 932‐5459 (775) 309‐3343

Jill KearnyMono County Local Enforcement Agency (LEA)

Mono County Environmental Health jkearney@mono.ca.gov (760) 924‐1846 (530) 304‐3911

Jim LeddyIncident Commander ‐ County Adminstrator

Mono County  jleddy@mono.ca.gov (760) 924‐1703

John Hower Engineering Contractor ‐ PRIME Geo‐Logic Associates (GLA) jmhower@geo‐logic.com (858) 451‐1136 (858) 864‐2584

Ken Stuart Community Liaison CalRecycle Ken.Stuart@calrecycle.ca.gov (916) 221‐1946

Kris Gretsinger Pacific States Project Manager Pacific States kgretsinger@pacificstates.net (510) 381‐8199

Louis MolinaMono County Local Enforcement Agency (LEA)

Mono County Environmental Health lmolina@mono.ca.gov (760) 924‐1845

Marvin Moskowitz, Director Inyo County LEA Inyo County Environmental Health mmoskowitz@inyocounty.us (760) 878‐0261

Matt Rodarte Debris Removal Crew Leader SUKUT mrodarte@sukut.com (714) 514‐6369

Melinda Stehr Debris Coordinator CalOES Melinda.Stehr@CalOES.ca.gov (916) 845‐8274

Mr. Kim LongneckerFive Bridges Road Facility (concrete recycling)

Granite Construction Company (760) 920‐7687 

Nancy McGee Hazardous Waste Contact DTSC nmcgee@dtsc.ca.gov (916) 255‐6585

Nicole Stetson District Manager for Lancaster LandLancaster Landfill ‐ Waste Management nstetson@wm.com (661) 223‐3418 (661) 816‐6147

Patrice Copeland Water Quality Permitting Regional Water Quality Control Board Patrice.Copeland@waterboards.ca.gov (760) 241‐7404

Paul Penn CalEPA Coordinator Office of Secretary Paul.Penn@calepa.ca.gov (916) 327‐9558

Scott Eagan Bishop Sunland Landfill Mgr Inyo County Solid Waste seagan@inyocounty.us (760) 937‐5497

ROUND FIRE DEBRIS REMOVAL OPERATIONS CONTACT LIST

Name Team Title/Job Title Agency/Company Email Office Mobile

Stephanie Young Planning Chief CalRecycle Stephanie.Young@CalRecycle.ca.gov (916) 341‐6118 (916) 996‐9261 (DROC)

Todd Gunnell SUKUT Project Manager SUKUT tgunnell@sukut.com (714) 904‐2126

Todd Thalhamer Operations Chief CalRecycle Todd.Thalhamer@CalRecycle.ca.gov (916) 341‐6356 (916) 798‐5464

Tony Dublino Solid Waste Superintendent Mono County Solid Waste tdublino@mono.ca.gov (760) 932‐5453 (760) 616‐0613

APPENDIX E

PROPOSED PROJECT SCHEDULE

ROUND FIRE DEBRIS PROJECT SCHEDULE

Feb‐15 Mar‐15 Apr‐15Number of Home Signups 13 13 17 17 17 17 30 30 30 30 30 39 39 39 39 39 39 39 39 39 39 39 39 39 39 39 39 39 39 39 39 39 39 39 39 39 39 39 39 39 39 39 39 39Number of Homes Completed 4 4 4 4 4 4 4 4 4 3Number of Homes Remaining 35 31 27 23 19 15 15 11 7 3 0Number of Divisions/Crews 4 4 4 4 4 4 4 4 4 3 1 1 1 1 1 1Description 22 23 24 25 26 27 28 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30Proclamation Signed

County of Mono MOU

County of Mono ROE

ICS Planning/Logistics Meeting

Draft Operations Plan

Site Background Sampling

Site Documentation

Asbestos Survey, Sampling, Results

Contractor Mobilizes

Debris Removal

Asbestos Removal

Confirmation Sampling

Erosion Control

Closeout/Demobilize

APPENDIX F

DEPARTMENT OF TOXIC SUBSTANCES ASBESTOS SURVEY FINDINGS

2/24/15 Round Fire

SITE NUMBER Type Notes

4866 Deer Peak Trail X stucco should be tested

280 Pinon  X Y 2 old kiln

55 Pinon X Y 22 stove rope gaskets, door material

370 Rim Rock X Y 3 4 pieces of chimney flue

460 Rim Rock X unknown age of home: stucco suspect

301 Rim Rock X

255 Rim Rock X

105 Sierra Wave X

WASTE? Y              N 

ASBESTOSY/N                     Bags

2/25/15 Round Fire

SITE NUMBER Type

276 Valley View X

97 Valley View X N

59 Valley View X N

89 Wilson X Y 1 mastic on old bathtub

159 Willow X N

507 Willow X N

519 Willow X Y 1 3 stove gaskets, 2 sq ft insulation

140 Willow X N

99 Willow X N

1046 Swall Meadows X Y 1 wood stove door

1274 Swall Meadows X Y 3 transite pipe, 2 stove gaskets

1430 Swall Meadows X

1450 Swall Meadows X Y 1 wood stove door & gasket

175 Foothill X Y 1 wood stove door, old fire bricks

193 Foothill X Y 1 wood stove door & gasket

153 Foothill X Y 1 3 sections of stove flue

461 Mountain Veiw X N

WASTE? Y              N 

ASBESTOSY/N                      Bags

2/26/15 Round Fire

SITE NUMBER Type Notes

9 Wilson X Y 1 stove gasket

11 Wilson X

826 Swall Meadows X N

45 Pine X

931 Swall Meadows X N

67 N. Valley View X Y 4 stove flue & collar, hard pack on dishwasher

72 N. Valley View X N

94 Mountain View X Y 1 2 sqft heat shield in garage

788 Mountain View X

818 Mountain View X

739 Mountain View X Y 1 woodstove gasket and door

926 Sky Meadow X Y 4 heat shield & mastic on chimney, old kiln small amt of heat shield remains

320 Mountain View X N

171 Pine X Y 1 stove door & gasket

WASTE? Y              N 

ASBESTOS Y/N                      Bags

APPENDIX G

GBUAPCD NESHAP ASBESTOS NOTIFICATION FORM

ASBESTOS NESHAP NOTIFICATION OF DEMOLITION AND RENOVATION

OPERATOR PROJECT # POSTMARK DATE RECEIVED NOTIFICATION #

I. TYPE OF NOTIFICATION ( O - ORIGINAL C- CANCELLED ) (R - REVISION -- WRITE REVISION #? ) --------------------------- II. FACILITY INFORMATION (IDENTIFY OWNER, REMOVAL CONTRACTOR, AND OTHER OPERATOR) OWNER NAME: ADDRESS: CITY: County: State: ZIP:

CONTACT: Telephone:

ASBESTOS REMOVAL CONTRACTOR: ADDRESS: CITY: State: Zip:

CONTACT: Telephone: Title:

DEMOLITION CONTRACTOR: ADDRESS: CITY: State: ZIP

CONTACT:

Telephone: Title:

III. TYPE OF OPERATION: (D-DEMO O-ORDERED DEMO R-RENOVATION E-EMERGENCY RENOVATION): IV. IS ASBESTOS PRESENT? ( YES / NO ) List Type of Asbestos Material (s) to be Removed:

V. FACILITY DESCRIPTION (INCLUDE BUILDING NAME, NUMBER AND FLOOR OR ROOM NUMBER) BUDG NAME: ADDRESS: CITY: County: State: ZIP:

SITE LOCATION: BUILDING SIZE: Number of floors: Age in years:

PRESENT USE: PRIOR USE:

VI. PROCEDURE, INCLUDING ANALYTICAL METHOD, IF APPROPRIATE, USED TO DETECT THE PRESENCE OF ASBESTOS MATERIAL:

NONFRIABLE ASBESTOS MATERIAL TO BE REMOVED

NONFRIABLE ASBESTOS MATERIAL NOT TO BE BEREMOVED

VII. APPROXIMATE AMOUNT OF ASBESTOS, INCLUDING: 1. REGULATED ACM TO BE REMOVED 2. CATEGORY I ACM NOT REMOVED 3. CATEGORY II ACM NOT REMOVED

RACM TO BE REMOVED

CAT I CAT II CAT I CAT I I PIPES: (Linear Feet )

SURFACE AREA (Square Feet )

VOL. RACM OFF FACILITY COMPONENT (Cubic Feet )

VIII. SCHEDULED DATES DEMO/RENOVATION (MM/DD/YY) Start: Complete: IX. SCHEDULED DATES ASBESTOS REMOVAL (MM/DD/YY) Start: Complete: Weekdays Work Hours:_________________ Weekend Work Hours:______________________

Page 1 of 2 – Continued on page 2

Great Basin Unified Air Pollution Control District 157 Short Street Bishop, CA 93514 TEL: (760) 872-8211 *FAX: (760) 872-6109

x. DESCRIPTION OF PLANNED DEMOLITION OR RENOVATION WORK, AND METHOD(S) TO BE USED: XI. DESCRIPTION OF WORK PRACTICES AND ENGINEERING CONTROLS TO BE USED TO PREVENT EMISSIONS OF ASBESTOS AT THE DEMOLITION AND RENOVATION SITE. XII. WASTE TRANSPORTER #1 ADDRESS: CITY: STATE ZIP

CONTACT PERSON: TELEPHONE:

XIII. WASTE DISPOSAL SITE: NAME: LOCATION: CITY: STATE ZIP

TELEPHONE: XIV. IF DEMOLITION ORDERED BY A GOVERNMENT AGENCY, PLEASE IDENTIFY THE AGENCY BELOW: NAME: TITLE:

AUTHORITY: DATE OF ORDER (MM/DD/YY) DATE ORDERED TO BEGIN: (MM/DD/YY)

XV. FOR EMERGENCY RENOVATIONS a) DATE AND HOUR OF EMERGENCY: (MM/DD/YY) b) DESCRIPTION OF THE SUDDEN, UNEXPECTED EVENT: c) EXPLANATION OF HOW THE EVENT CAUSED UNSAFE CONDITIONS OR WOULD CAUSE EQUIPMENT DAMAGE OR AN UNREASONABLE FINANCIAL BURDEN: XVI. DESCRIPTION OF PROCEDURES TO BE FOLLOWED IN THE EVENT THAT UNEXPECTED ASBESTOS IS FOUND OR PREVIOUSELY NONFRIABLE ASBESTOS MATERIAL BECOMES CRUMBLED, PULVERIZED, OR REDUCED TO POWDER. XVII. I CERTIFY THAT AN INDIVIDUAL TRAINED IN THE PROVISIONS OF THIS REGULATION (40 CFR PART 61, SUBPART M) WILL BE ON-SITE DURING THE DEMOLITION OR RENOVATION AND EVIDENCE THAT THE REQUIRED TRAINING HAS BEEN ACCOMPLISHED BY THIS PERSON WILL BE AVAILABLE FOR INSPECTION DURING NORMAL BUSINESS HOURS ( REQUIRED 1 YEAR AFTER PROMULGATION) _________________________________________________________ ____________________________ (SIGNATURE OF OWNER/OPERATOR) (DATE) XVIII. I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT. _________________________________________________________ _____________________________ (SIGNATURE OF OWNER/OPERATOR) (DATE)

Page 2 of 2

APPENDIX H

BENTON CROSSING LANDFILL PERMITS

EFFECTIVE JANUARY 1, 2013

Mono County Department of Public Works

GATE FEE SUMMARY

Benton Crossing Landfill

Mono County Solid Waste Program

Category / Item Description Unit Cost

BASE RATE (Basis of Gate Fee for All Municipal Solid Waste) ............................................. $74.00 per ton

Minimum Gate Fee ........................................................................................................................ $5.00 per load

Mixed Household and Commercial Waste ................................................................................ $74.00 per ton

Construction and Demolition (C&D) Waste.

Mixed Building C&D Debris (mixed lumber, drywall, shingles, other bldg. debris) ........................ $74.00 per ton

Inert Construction and Demolition Debris.

Clean loads of gravel, soil, or asphalt grindings ................................................................ $5.00 per load (pieces no larger than 6” at its largest dimension)

Clean loads of small broken asphalt or concrete only ..................................................... $11.00 per ton (pieces no larger than 12” at its largest dimension)

Mixed inert debris or loads of large concrete / asphalt chunks ....................................... $33.00 per ton

Wood, Green Waste, and Similar Organics.

Organics7 (clean loads of bark, hay, grass clippings, sod, tumbleweeds) ........................................ $5.00 per load

Wood (clean loads of scrap wood, lumber, prunings, brush, tree limbs) ......................................... $17.25 per ton

Tree Trunks (dia. > 18”) and Stumps ....................................................................................... $74.00 per ton

Recyclables, Electronic Waste, Household Hazardous Waste (HHW), Universal Waste.

Batteries (lead-acid for vehicles or other motor-powered equipment) ................................................. No Charge

Recyclables (cardboard, glass / plastic bottles, aluminum cans, other – see gate attendant) ............... No Charge

Household Hazardous Waste (paint, pesticides, solvents, cleaning products, other HHW) ............... No Charge

Universal Wastes (fluorescent tubes, household batteries, mercury devices, etc.) ............................ No Charge

Used Motor Oil or Oil Filters ....................................................................................................... No Charge

Cathode Ray Tubes (televisions & computer monitors) .......................................... $5.50 ea. + $17.25 per ton

Tires.

Whole Tires.

Passenger car / truck tires (dia. < 42” or width < 11”) ...................................... $5.50 ea. + $17.25 per ton

Oversized tires and tractor tires (dia. > 42” or width > 11”) ............................ $65.75 ea. + $17.25 per ton

Additional surcharge for any tire still on the rim ............................................ $5.50 ea. + $17.25 per ton

continued…

Gate Fee Summary—Benton Crossing January 1, 2013

Mono County Department of Public Works

Category / Item Description Unit Cost

Scrap Metal and Appliances.

Scrap Metal (clean loads of scrap metal, including metal trailers, motorcycles, car parts) 1 ............. $17.25 per ton

Auto Bodies 1

..................................................................................................... $16.50 ea. + $17.25 per ton

Refrigerated Appliances 2 .................................................................................. $24.75 ea. + $17.25 per ton

Non-Refrigerated Appliances 2 ........................................................................... $11.50 ea. + $17.25 per ton

Animal Carcasses

Small – weighing less than 50 lbs. (e.g., cat, small dog) ............................................................. $5.00 each

Medium – weighing between 50-200 lbs. (e.g., large dog, goat, sheep) .................................... $10.00 each

Large – weighing over 200 lbs. (e.g., horse, cow, other livestock) .............................................. $25.00 each

Mobile Homes, House Trailers, Campers, Boats

Mobile homes, house trailers, and campers 1 ......................................................................... $74.00 per ton

Boats and personal watercraft ................................................................................................ $74.00 per ton

Special Handling Items.

Base Rate ............................................................................................................................... $74.00 per ton

Additional charge for each half hour required to process the load. ........................................ $20.00 per ½-hr

Surcharge for loads larger than 16 cubic yards at a transfer station .................................... $100.00 per load

NOTES:

1. Tires, rims, or appliances included on trailers, vehicles, mobile homes, etc., will be charged applicable fees.

2. Refrigerated appliances include refrigerators, freezers, and air conditioners. Non-refrigerated appliances include dishwashers, dryers, microwaves, ovens, stoves, trash compactors, washers, water heaters, etc.

3. Gate attendant shall use his/her best judgment in assessing the load delivered to the facility and determining the applicable gate fee based upon reasonable inspection and measurement. Such estimate shall be final.

4. Charges may be rounded to the nearest $0.25. Charges determined on a “per ton” basis may be assessed partial units in increments within the accuracy of the scale equipment.

5. All customers are responsible for ensuring that the full content of their load is disposed in the proper location or storage container. Any portion of a load insufficiently disposed and requiring management by the gate attendant or other site personnel is subject to a processing fee under “Special Handling Items.”

6. Barrels, drums, tanks, or any other liquid-tight storage container must be drained of its contents. Any such item greater than 55-gal. capacity that previously stored petroleum-based products is prohibited.

7. Manure is exempt from the $5 per load charge.

Additional specifications and restrictions apply. Please contact the Mono County Department of Public Works at 760.932.5440 for details, questions, to request a complete fee schedule, or to set up a charge account.

APPENDIX I

BISHOP-SUNLAND LANDFILL PERMITS

ABOUT USMissionVision

RECYCLE

Recycling in Inyo CountyPlaces to RecycleRecycling Companies

WASTE DISPOSAL

Locations & HoursLandfills & Transfer Station LocationsItems Accepted & FeesHousehold Hazardous WasteHazardous Wastee Collection Events Holiday & Facility ClosuresAsbestos DisposalContaminated Soil TreatmentHome Generated Sharps

WHAT'S NEW

Accepted only at theBishop-Sunland Landfill

AsbestosNon-friable only-Minimum- $35.00 charge $56.00 per / cu. yd. or $2.00 / cu. ft. whichever is greater

Contaminated soil (gasoline, diesel, and/or related constituents) - $16.00 / cu. yd.Out-of-County of Inyo - $32.00 / cu. yd.

HOME I CONTACT US I SITE MAP

Inyo County Landfill Items Accepted & Fees

Fees effective May 1, 2014Gate Entrance Fee - $5.00

Note: If entire load content is recyclable material only, gate fee does not apply.

A Gate Fee is charged in addition to all items listed below unless noted otherwise.

Gate Pass 12 visits $50.00

Gate Pass 26 visits $90.00

Animal Carcasses (each)- less than 25 lbs. -------------------------- $ 5.00 - between 25-200 lbs.-------------------- $10.00 - over 200 lbs. ----------------------------- $30.00Note: Not accepted at transfer stations

Construction & Demolition (C&D)Commercial & Residential <1 cy $14.00------------------------------ > 1 cy $14.00 ea c.y. Broken- Concrete-------------------<1 cy- $22.00----------- ------------------------------ > 1 cy $22.00 ea c.y.--Mixed C&D-----------------<1 cy $50-------------------------------------------------->1cy $50 per cy--Clean Soil (no debris & no rocks larger than a baseball) --------------------------------No Charge

Clean Scrap Metal --------------No Charge(If material can be separated easily)

Household Waste --------------- Gate Fee for 1st 1-c.yd. $5.00 ea additional c.y.

Furnishings -------------------- $4.00/ itemThrift Shops that regularly accept household furniture and clothing -----------------No Charge

Treated Wood Waste -----Not Accepted(Inyo County Landfills Cannot Be permitted to take Treated Wood)

Special HandlingBase rate (first ½ hour) --------$35.00Each additional ½ hour -------- $47.00

Trailers All TowTrailers < 20'------------------$30.00 greater than 20'------------------------$50.00 Camper Shells, Tonneau covers----$30.00

Mobile homes, campers, camp trailers, house trailers.

--------------------------------------< 15’ $90.00--------------------------------------->15’ $130.00Note: Not accepted at transfer stations

Vehicle/Vessel BodiesMotorcycles, Personal water craft (Jet skis, wave runners, Passenger vehicles and auto bodies ---Not Accepted at Any Site---

Boats ( All metal body not accepted) - Fiberglass and/or wood < 20’ in length ---------------------------- $45.00> 20’ in length ---------------------------- $65.00

OrganicsGreen Waste (Lawn clippings, leaves, slash,tree trimmings, trees, shrubs, yard waste, woodchips)- Residential-----1st 3-c.yds. Gate Fee only ----------------------------($2.00 ea additional c.y.) - Commercial ------------------------$4.00/ c.y.

Mfg. Wood Material-<1c.y. Gate Fee only ------------------------------------or $4.00 ea c.y.

Manure --------------------<1 cy Gate fee only ------------------------------------> 1cy $9.00/ c.y.

Page 1 of 2Inyo County Waste Management Department: Landfills, Transfer Stations and Recycling ...

3/5/2015http://inyocountysolidwaste.com/fees.html

Tires (max. 9 - per visit) - < 19”rim size ---------------------------$4.00 each- > 20"- 24.5”----------------------------$8.00 each Tractor/Heavey Equipment Tires ---------------------lesss than 100 lbs----------------------------$30-----Greater than 100 and up to 150 lbs----$40-----Greater than 150 and up to 200 lbs----$50---Motorcycle, Go-Cart, Golf Cart, Trailers and equipment tires (all sizes) ------------$3.00 eachBicycle Tires -------------------------------No ChargeAltered Tires --------------------- $127.00 per c.y. Note: Tires on rims not accepted

Mixed debris loads ------------------------Residential or Commercial --------- $16.00/ c. y. (Defined as a load of recyclable and/or organic material mixed with solid waste)

Tree Stumps----------------< 24" $4.00/each ---------------------------------> 24" $12.00/eachNote: Not accepted at transfer stations

Youth Groups, Civic Clubs and Community non-profits that collect waste as part of a anti-litter cleanup event or conduct a fund raising event or yard sale - No Charge(No gate fee or disposal fee)

Information Contact: telliot@inyocounty.us (760) 873-5577Administrative Services: 163 May St., Bishop CA 93514

Copyright 2008-2012 © Inyo County I Website designed by Troy Creative

Page 2 of 2Inyo County Waste Management Department: Landfills, Transfer Stations and Recycling ...

3/5/2015http://inyocountysolidwaste.com/fees.html

APPENDIX J

LANCASTER LANDFILL PERMITS

Effective January 1, 2015

LANCASTER LANDFILL & RECYCLING CENTER

Service and Fee Schedule

Rates

Municipal Solid Waste (MSW) Antelope Valley **Non-Antelope Valley

MSW Residential $59.04/ton $44.80 min. $61.16/ton $46.92 min.

No Trailer (Car, Truck, Van, SUV) $44.80/load $46.92/load

W/ Trailer 6’ and under (Car, Truck, Van, SUV) $46.05/load $47.70/load

MSW Commercial/Industrial $59.04/ton $59.04 min. $61.16/ton $61.16 min.

**Material originating outside of the Antelope Valley

Recyclable Materials Rate

Greenwaste Residential $39.40/ton $28.45 min.

No Trailer (Car, Truck, Van, SUV) $28.45/load

W/ Trailer 6’ and under (Car, Truck, Van, SUV) $28.45/load

Greenwaste Commercial/Industrial Loads $39.40/ton $39.40 min.

Wood (clean) – Residential $39.40/load $28.45 min.

Wood (clean) – Commercial/Industrial Loads $39.40/ton $39.40 min.

Sod (clean) – Residential $50.35/ton $37.21 min.

Sod (clean) – Commercial/Industrial $50.35/ton $50.35 min.

Dirt (clean) $10.94/ton $10.94 min.

Construction/Demo – C&D $70.05/ton $70.05 min.

Clean Asphalt/Concrete (clean) $26.27/ton $26.27 min.

Appliances $24.07 ea.

Mattresses $16.42 ea.

Tires – Passenger or light truck tires $8.76 ea.

Tires w/rim – Passenger or light truck tires $17.52 ea.

Truck Tires – Truck or Tractor $16.42 ea.

Truck Tires w/rim – Truck or Tractor $32.84 ea.

TV’s & Computer Monitors $ 0.00 ea.

All loads subject to Environmental Fee, Fuel Surcharge and RCR Charge

Environmental Fee

$ 8.00/load 2 tons or less /$ 16.00/loads over 2 tons

Fuel Surcharge A percentage of the total ticket amount based upon the

national average price of diesel fuel.

Regulatory Cost Recovery A percentage of the total ticket amount less the Fuel

Surcharge.

Non - Acceptable Materials

Hazardous materials, including but not limited to:

Batteries

Automotive fluids (fuel, antifreeze, oils)

Paint, lacquer, stain, thinner, varnish, wood preservatives

Chemicals of any kind (pool chemicals, pesticides, weed killer)

Fluorescent Light Tubes and Ballasts

Liquids

Water-Soluble Solids (salt, borax, lye, caustics/acids)

Medical/Biological/Infectious Waste

Septic Tank or Chemical Toilet Waste

Automobile Bodies

Radioactive Materials

PCB Waste

AVECC Antelope Valley Environmental Collection Center

1200 W. City Ranch Road, Palmdale CA 93551 Residents Dispose of Household Hazardous Wastes and Electronics for free

1st

& 3rd

Saturday of each month from 9:00 am to 3:00 pm

For more information about disposing of household hazardous wastes or the AVECC please visit www.888cleanla.com or call 888cleanla.

All customers will be required to complete a Waste Origin Reporting Form. LA County requires all loads be securely covered or a $25 fee will be charged.

Hours of Operation

Monday – Friday 9:00 am to 4:30 pm All vehicles must be on the scale by 4:15pm

All vehicles must be unloaded by 4:45pm

Saturday 8:00 am to 12:00 pm All vehicles must be on the scale by 11:45am

All vehicles must be unloaded by 12:15pm

No refunds for partially unloaded vehicles.

600 East Avenue F, Lancaster CA 93535 Phone (661) 726-3468 Fax (661) 945-9797 www.KeepingAVclean.com

Payment Information

Cash, American Express, Discover, MasterCard or Visa. No checks accepted. We reserve the right to refuse any load.

Effective January 1, 2015

LANCASTER LANDFILL & RECYCLING CENTER

Important Information Random Load Checks

This facility conducts load checks. Illegally disposal of materials may result in further action as described by State law. Please cooperate with landfill personnel if they request to inspect and document your refuse load.

No Scavenging Allowed!

To protect human health and the environment, State law prohibits the removal, from this facility, of any materials intended for disposal. Materials recovered and recycled in accordance with State issued permits excluded.

Material Definitions

Industrial Waste & Soil Requires Pre-Approval

Industrials wastes, large volume soil jobs, non friable asbestos, treated wood and municipal waste water treatment plant sludge all require pre-approval prior to delivery and acceptance. Loads not pre-approved will be rejected. For these types of wastes, please contact the Technical Services Center (TSC) at (866) 598-6127 or visit www.wmsolutions.com.

Dirt (clean): Granular soil such as clay, sand or silt that breaks apart when handled by light duty construction equipment such as a small backhoe or skip loader. No trash, metal, excessive rock, concrete, asphalt or wood. Less than 10% root and/or grass contamination. Loads with these contaminants will be charged as MSW.

Asphalt/Concrete (clean): Any combination of concrete, asphalt or asphalt grindings which is less than 24 inches (2 feet) in any 2 dimensions. Loads containing debris exceeding this size limitation will be charged as MSW. Loads with debris greater than 6 feet in any dimension may be assessed an additional handling fee (hard to handle fee). Concrete debris should have minimal re-bar, or metal protruding from the individual pieces of concrete. No trash, excessive metal, wood, roots or grass contaminants. Loads with these contaminants will be charged as MSW. Loads with soil content greater than 10% will be charged as MSW.

Woodwaste and Greenwaste (clean): Any combination of clean wood (no painted or treated wood), tree trimmings and other plant matter not listed below. Minimal roots and soil content allowed. No trash, Yucca trees/bushes, Joshua trees, Palm trees, palm fronds, Rosemary, Tumbleweeds, Bamboo, Sage, Grass, Pine needles, Leaves, Sod, Hay, Oleander, Telephone poles, Railroad ties, Creosote bushes, any kind of treated wood or wood with glue or any kind of adhesive content allowed. Loads with these contaminants will be charged as MSW.

Construction and Demolition Waste – C&D: Mixed load consisting of but not limited to: lumber, wood, wood products, roofing materials, plastic pipe, wall board material, rock, concrete, brick, cardboard, etc.

Appliances: Major appliances such as washers, dryers, water heaters, refrigerators are accepted for recycling.