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HomeMy WebLinkAbout26- Public Works CITY OF SAN BERNARDINO — REQUEST FOR COUNCIL ACTION ORIGINAL From: Nadeem Majaj, Director of Public Subject: Resolution of the Mayor and Works Common Council of the City of San Bernardino ratifying the Application for Dept: Public Works — Integrated Waste the submittal of the Waste Tire Cleanup Management Division and Amnesty Event Grant Program from the California Department of Resources Date: February 8, 2011 Recycling and Recovery (CalRecycle). Meeting Date: March 7, 2011 Synopsis of Previous Council Action: 03/06/06 Reso 06-68 ratifying submittal of the Waste Tire Cleanup/Amnesty Grant Application 02/20/07 Reso 07-64 authorizing submittal of Waste Tire Cleanup/Amnesty Grant Application Recommended Motion: Adopt Resolution. ignature Contact person: Nadeem Majaj, Director of Public Works Phone: 5140 Supporting data attached: Ward: All Staff Report, Resolution, Grant Application FUNDING REQUIREMENTS: Amount: $20,000 Source: Grant Revenues/No impact to the General Fund Finance: Council Notes: Agenda Item No. Yo 03-07-90 H CITY OF SAN BERNARDINO — REQUEST FOR COUNCIL ACTION Staff Report SUBJECT: Resolution of the Mayor and Common Council of the City of San Bernardino ratifying the Application for the submittal of the Waste Tire Cleanup and Amnesty Event Grant Program from the California Department of Resources Recycling and Recovery (CalRecycle). BACKGROUND: The California Department of Resources Recycling and Recovery (CalRecycle) receives an annual appropriation from the California Tire Recycling Management Fund to administer the Tire Recycling Act and related legislation. In turn, CalRecycle has allocated funds for the Waste Tire Cleanup and Amnesty Event Grant Program. Funds allocated by CalRecycle for the Waste Tire Cleanup and Amnesty Event Grant Program are divided into two funding categories, Waste Tire Cleanup Projects and Waste Tire Amnesty Events. Eligible costs for the Waste Tire Cleanup Funds are the I cost of collecting, transporting, and disposing of illegally dumped waste tires that has occurred along the public right-of-ways and/or illegal dump sites on public and private property. The intent of this activity is to remediate threats to public health, safety, and property. Eligible cost for the Amnesty Event funds are collection, transportation, and disposal of waste tires collected from residents at special collection events. In FY 05/06, the City identified three illegal dumpsites that ranged from 50 to 500 tires. Due to the proximity to homes, businesses, and schools, all were considered a serious threat to public health and safety. City staff and volunteers cleaned up and properly disposed of over 3,000 tires illegally dumped in the public right of way or in vacant lots at a cost of approximately $10,000 which was covered by the Waste Tire Cleanup and Amnesty Grant. In FY 06/07 the City's Right-of-Way crew and volunteers removed small amounts of waste tires on a weekly basis throughout the city. If waste tires and other illegally dumped items are not removed immediately, they tend to increase in volume and become a greater problem than originally discovered. Overall, the waste tire clean-up efforts resulted in a total of 120 tons of tires being properly disposed, which cost approximately $17,000 and was covered by the Waste Tire Cleanup and Amnesty Grant. Currently, the City is experiencing an influx of waste tires that are being dumped illegally despite the fact that the City continues to offer curbside collection of used tires from residential customers. In addition, to offset the influx of waste tires, the City annually applies for other grant funding (Tire Enforcement) to address and identify those potential businesses and individuals responsible for illegally dumping tires. The grant funds will be used by the City to offset the personnel cost to collect the tires, disposal and hauling costs of waste tires anticipated to be illegally dumped during the grant term. 1 1 : CITY OF SAN BERNARDINO - REQUEST FOR COUNCIL ACTION Staff Report-Continued The grant application deadline for the 8tr' Cycle waste tire cleanup and amnesty event grant program was February 18, 2011. The grant term is from July 1, 2011 through June 30, 2012. Staff recommends adoption of the attached resolution authorizing submittal of the application for grant funds. FINANCIAL IMPACT: The total amount being requested in grant funding is $20,000. There are no matching funds required from the City. Of this total request, $10,000 will be utilized to offset personnel and hauling costs. The remaining $10,000 will be utilized for tire recycling. RECOMMENDATION: Adopt Resolution. 2 RESOLUTION NO. 00py 1 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN 2 BERNARDINO RATIFYING THE SUBMITTAL OF THE APPLICATION FOR WASTE TIRE CLEANUP and AMNESTY GRANT PROGRAM FROM THE CALIFORNIA 3 DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY (CALRECYCLE). 4 WHEREAS, funds are available from the California Department of 5 Resources Recycling and Recovery (CalRecycle) for grants to local government 6 to pay for the costs of cleanup, abatement, and other forms of remedial action 7 related to the disposal of used whole tires; and 8 9 WHEREAS, the City proposes to implement a Waste Tire Cleanup that 10 involves collection and proper disposal of illegally dumped waste tires; and 11 WHEREAS, the City has demonstrated it has sufficient staff resources, 12 technical expertise, and experience with similar projects to carry out the 13 proposed program; and 14 WHEREAS, the grant application deadline was February 18, 2011. The 15 grant term is July 1, 2011 through June 30, 2012. 16 17 NOW, THEREFORE, BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO AS FOLLOWS: 18 SECTION 1. Submittal of an application to the California Department of 19 20 Resources Recycling and Recovery (CalRecycle) for a Waste Tire Cleanup and 21 Amnesty Event Grant Programs, a copy of which is attached hereto and 22 incorporated herein as Exhibit "A," is hereby ratified. The City Manager of San 23 Bernardino, or his designee, is further authorized to (1) submit all supporting 24 documents required by the Waste Tire Cleanup and Amnesty Grant Program 25 during its pendency, including, but not limited to, payment requests, (2) to 26 administer grant funds; and (3) to implement and carry out the purposes 27 28 specified in the grant application. iii ��QQ y ' 1 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO RATIFYING THE SUBMITTAL OF THE 2 APPLICATION FOR WASTE TIRE CLEANUP and AMNESTY GRANT 3 PROGRAM FROM THE CALIFORNIA DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY (CALRECYCLE). 4 1 HEREBY CERTIFY that the foregoing resolution was duly adopted by 5 6 the Mayor and Common Council of the City of San Bernardino at a 7 meeting thereof, held on the day of 8 2011 by the following vote, to wit: 9 10 Council Members: Ayes Nays Abstain Absent 11 MARQUEZ 12 VACANT Ilk 13 BRINKER 14 SHORETT 15 KELLEY 16 JOHNSON 17 18 MCCAMMACK 19 20 City Clerk 21 The foregoing resolution is hereby approved this day of 22 2011. 23 24 Patrick J. Morris, Mayor 25 City of San Bernardino 26 Approved as to form: 27 28 /alnps F. Penman, City Attorney EXHIBIT A calnecycleo December 2010 Natural Resources Agency Department of Resources Recycling and Recovery (CalRecycle) LOCAL GOVERNMENT WASTE TIRE CLEANUP AND AMNESTY EVENT GRANT PROGRAMS APPLICATION TCA8 Cycle - FISCAL YEAR (FY) 2010/11 i j jY 1 page a GrantApplication Form................................................................................................................................2 `} Environmental Justice Certification..............................................................................................................2 ResolutionRequirement................................................................................................................ Environmentally Preferable Purchases and Practices Policy Requirement...................................................3 Acceptanceof Grant Provisions....................................................................................................................3 ApplicationCertification...............................................................................................................................3 Waste Tire Cleanup Project(s)Description...................................................................................................4 Waste Tire Amnesty Event(s)Description....................................................................................................4 Work Plan Waste Tire Cleanup Projects 5 Work Plan(Waste Tire Amnesty Events).....................................................................................................7 Budget Waste Tire Cleanup Projects) .......................................................................................... Budget Waste Tire Amnesty Events 8 General Checklist of Business Permits,Licenses and Filings.......................................................................9 ApplicationChecklist..................................................................................................................................11 Mailed applications must be postmarked no later than February 18,2011. Hand delivered applications must be received and date stamped by CalRecycle Staff no later than 3:00 p.m.on February 18,2011. Late applications will be disqualified. Emailed or faxed applications will not be accepted. Please follow instructions in the Application Guidelines and Instructions when completing this application. The Application Guidelines and Instructions are critical to properly completing and submitting this application. Applications become the property of CalRecycle and are subject to disclosure under the Public Records Act. Do not submit confidential information. Applications sent by U.S.Postal Service or a commercial delivery service should be sent in a manner that allows for tracking by the sender and that provides an addressed and dated receipt. Failure to do so is at the risk of the applicant and if delivery is delayed or the application is lost by the Post Office or delivery service, the burden is on the applicant to demonstrate timely mailing or delivery of the application. - 4 } I STATE OF CALIFORNIA DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY(CalRecycle) GRANT APPLICATION FORM CalRecycle 243-TCA(Revised 12/10) LOCAL GOVERNMENT WASTE TIRE CLEANUP AND AMNESTY EVENT GRANT PROGRAMS -TCA8 (FY 2010/11) Complete and submit all sections. APPLICANT/ORGANIZATION NAME(MUST MATCH RESOLUTION): i CLEANUP PROJECTS i 20000 i AMOUNT: City of San Bernardino AMNESTY EVENTS PARTICIPATING JURISDICTIONS(FOR REGIONAL PROGRAMS ONLY): AMOUNT: I —REQUESTED TOTAL �1 AMOUNT: 20000 (ROUND AMOUNTS TO THE NEAREST WHOLE DOLLAR) I MAILING ADDRESS: PROJECT ADDRESS: 300 North D Street CITY: CITY: an Bernardino COUNTY: ZIP CODE: COUNTY: ZIP CODE: San Bernardino 92418 PRIMARY CONTACT NAME: SIGNATURE AUTHORITY NAME: AUTHORIZED DESIGNEE NAME: (AS AUTHORIZED IN RESOLUTION) (IF APPLICABLE,AS AUTHORIZED IN LETTER OF DESIGNATION- LOD,SEE APPENDIX A FOR MORE INFO.) Deborah Allen Charles McNeely Nadeem Majaj TITLE: TITLE: TITLE: Environmental Projects Manager City Manager Director of Public Works TELEPHONE NUMBER: TELEPHONE NUMBER: TELEPHONE NUMBER: 909-384-5549 909-384-5122 909-384-5140 FAX NUMBER: FAX NUMBER: FAX NUMBER: 909-384-5190 1 909-384-5138 909-384-5190 EMAIL ADDRESS: EMAIL ADDRESS: EMAIL ADDRESS: allen de sbcit .or mcneel ch sbcit .or mqM_na@sbcity.org INDICATE WHICH TYPE OF ENTITY YOU ARE(CHECK ONLY ONE): ®CITY ❑COUNTY ❑CITY&COUNTY ❑QUALIFYING INDIAN TRIBE ❑OTHER(LIST TYPE) LEGISLATIVE DISTRICT NUMBERS (TO FIND YOUR DISTRICT, USE MAILING ADDRESS ABOVE AND GO TO www.calrecycle.ca.gov/Profiles/Juri FEDERAL TAX IDENTIFICATION NUMBER: ASSEMBLY: SENATE: 62 32 95-6000772 CalRecycle Grantees must in the performance of the Grant Agreement conduct their programs,policies, and activities that substantially affect human health or the environment in a manner that ensures the fair treatment of people of all races, cultures, and income levels, including minority populations and low-income populations of the State. (Govt. Code§65040.12(e)and Public Resources Code§71110(a)) t ® We acknowledge that our organization will comply with these principles of Environmental 1 Justice. Local Government Waste Tire Cleanup and Amnesty Event Grant Programs,TCA8(FY 2010/11) 2 STATE OF CALIFORNIA DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY(CalRecycle) GRANT APPLICATION FORM CalRecycle 243-TCA(Revised 12110) Submit either an approved Resolution,valid up to 5 years,with your application or the following acknowledgement. (If applicable, submit a current Letter of Designation(LOD)for signature designee) Note:All previous approved multryear Resolutions must be updated to include new Department name.See Application Guidelines&Instructions or Resolution and Letter of Designation(LOD)information and examples. ❑ We acknowledge that an approved Resolution and,if applicable,LOD designating additional j signature authority is enclosed in the application. We acknowledge that our approved Resolution must be received by CalRecycle no later than ® March 18,2011. We further acknowledge that if our Resolution is received after this date, our application will be disqualified. Environmentally preferable purchasing protects human health and environmental well-being by reducing the procurement of goods and services that result in larger volumes of waste and pollutants. The Legislature declares that the responsibility of environmentally preferable purchasing shall be that of any agency that does procuring on behalf of the state(Chan, Statutes of 2002, Chapter 575), and this extends to grantees using state funds. j "Environmentally preferable purchasing(EPP)"as defined in PCC section 12400 means "the procurement or i acquisition ofgoods and services that have a lesser or reduced effect on human health and the environment when compared with competing goods or services that serve the same purpose. This comparison shall take into consideration, to the extent feasible, raw materials acquisition,production, manufacturing,packaging, distribution, reuse, operation, maintenance, disposal, energy efficiency,product performance, durability, safety, the needs of the urchaser, and cost." In other words, EPP considers, among other things, the environment,performance and cost." I Yes,our entire organization' has an Environmentally Preferable Purchasing and Practices ❑ Policy. Date adopted: I No,our entire organization does not have an Environmentally Preferable Purchasing and j Practices Policy. We acknowledge that our organization must adopt one by March 18,2011 ® and send notification to the CalRecycle of such adoption by secondary deadline; March 18, 2011,or our application will be disqualified. By checking this box,Applicant acknowledges that submittal of this application constitutes ® acceptance of all Grant Agreement provisions as contained in the Terms and Conditions and Procedures and Requirements.To download these documents see: h ://www.calrec cle.ca. ov/tires/Grants/Cleanu /FY201011/default.htm CertiFcadon:I declare, under penalty of perjury under the laws of the State of California, that I have read all information in the Application Guidelines and Instructions and that all information submitted for the Ca/Rec /e's consideration for award of grant funds is true and correct to the best of my knowledge. X Signature Authority-as duttforLzed in Resolution or Letter of Commitment;or Date Authorized Designee-as authorized in submitted Letter of Designation ideem Majaj Director of Public Works erint Name Print Title 1 "Entire organization"refers to the entire city,county or non-profit applicant, not an individual office or subunit of the larger entity. 1 ­1!_n..n n+IA1a +o Tiro r1montin­4 Amne¢+v Fvcn+r2­+Pmnmmc Tr'AR/FV 2n1n/111 $ STATE OF CALIFORNIA DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY(CalRecycle) GRANT APPLICATION FORM CalRecycle 243-TCA(Revised 12/10) Provide the location,parcel number and a description of each site,which includes proximity to populated areas or sensitive environments,number of tires,proposed method of remediation,and end use.Photographs should also be included. Please include a quote from a registered waste tire hauler to justify the estimated cost per tire.If there are more than 500 tires on private property and the owner is not responsible for the illegal disposal of the tires,then an affidavit for each site must be included with the application. See Application Guidelines and Instructions for the affidavit form. See attachments How many tires are estimated to be removed:2750 /ill these tires be recycled or landfilled? recycled Is the applicant able to utilize the California Conservation Corps or Local Community Conservation Corps for tire removal?not currently Provide a description of the amnesty event(s),including the estimated cost per tire for each event(grant amount divided by number of tires to be collected). Please include a quote from a registered waste tire hauler to justify the estimated cost per tire. NA How many tires are estimated to be removed: NA /ill these tires be recycled or landfilled? NA Is the applicant able to utilize the California Conservation Corps or Local Community Conservation Corps for tire removal?NA r:—m r-mnt Prnnramc TCAS(FY 2010/11) 4 _N N O O N N C C r r O O N N H U w O N d w N LO a 2 =-0 U Z Z m >, Q ~ U U w J w OU --3 to w U w a n rr cc 7 z r W c cal N p o z a Q p (.) i a Q o 0 Z wN 9 w N _ to E H F o w Z U O O N > > C O � LL O O O O co e- U J F O Q z p m uj J o cr a m w o C7 N >- C N LL W N E Q a N c m N n 0& LL Z •N- 0) L O U C c f= g Q " Z cTi ro W Yr ci o Z c D Q c o J a w J m Q N a C C L~ V CD Q Z O T w- ll�Qy 0 Z O L N +.. 0 7 U C7 U N J s H z w � W CJ W W z < r Q LLJ a W z w w w w P 0 ea a o a r i Z d 0 ILI w �: Z o x W N D O LL W Q J U LL Q F Z m LU r o C2 a � o m 0 N C) }� c LL � W d E Q v A � a 0& � " a Oy sE ' a z z L a. . IL Cl) J E � QN a a ;, H °-? Q 'o �Z 0 w o v U' U C) CD \ \ m \ R R / 0 e e LLI Z cl� _ o °>1 a o D ` f b �. } 2 \ � t w § > U 2 j 0- < w z w \ �� \ � \ j � LU / w Cl) o CO �6 0 ) w 82 / j \ > LLJ - } ~ \ j 0 k 0 ® \ c = % \ \ k \ / § § § q 2 § U) rE k k ~CU cn 3 3 C) k LLI / a) 0 < ° S Q \ 7 � CL / ( 22 g % § § O_ 2 : _ e � � k c § E \ \� F / o k � C) ` C }} o 7 CU n ƒ m ! a7 } � o 06 K � � 0 CD / / / & / k E k i « ; z 0 -0 a o �K \ \ . k20 wz j / � \ f \ e k \ B & k . / ¥ U / LO CN � 2 / ° 0 § .. \ \ © 2 » E a k , / 7 w I c LLJ # { / U) k o � e ? § © E \ p \ z E § w / / . R o ) ® ] E k \ � ) e o U 7 L �_ § § k k / } \ Lr- CL CL » % IL 2 ® < k k k k ® R ° U 0 3 0 0 \ W | u 2 k (D § § ca \ d E \C /O \ j Z § O /) U) & « b $` \ ° CL , . C & \ / , \ a) § ^ K ƒ n 0 7 § ¥ CL Q [ � o � £ � c \ k w k § CD k 3 2 � © - ° § § 2 0 ¥ Q . m @ E % t § A_ / / } / / / ( , o o Q LB & w cri u STATE OF CALIFORNIA DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY(CalRecycle) ,ENERAL CHECKLIST OF BUSINESS PERMITS, LICENSES AND FILINGS CalRecycle 669(Rev.01/10)) GRANT APPLICANT/GRANTEE NAME City of San Bernardino GRANT NAME AND CYCLE T� G7�,NLIMBER,IF APPLICABLE DATE SUBMITTED/UPDATED Waste Tire Cleanup/Amnesty Grant Program 2-8-11 Mark(✓or X)appropriate box on each line below. All lines must be completed. Note: This list is not all-inclusive. Grant Applicant/Grantee must list other critical permits/licenses/filings not identified below. Grant Applicant/Grantee currently holds this valid permit/license/filing Grant Applicant/Grantee will modify and/or obtain this permit/license/filing This permit/licensemling is not applicable for,this grarit pfotect or business ❑ ❑ ® Authority to Construct/Permit to Operate Air Quality Management District El El ® Building Construction Permit City or County ❑ ❑ 0 Business License City or County ❑ ❑ ❑ Fictitious Business Name Filing County ❑ ❑ ❑ Land Use Permit/Zoning Clearance/Conditional Use Permit City or County ❑ ❑ ® Permit By Rule(PBR)for Permanent HHW Facilities or Temporary City, County or Cal/EPA-DTSC Collection Events ❑ ❑ Waste Hauler Permit City or County ❑ ❑ Antifreeze, Battery, Oil& Paint(ABOP)Notification I CUPA or CaVEPA-DTSC j ❑ ❑ ® Corporate, Company or Partnership Filings Ca. Secretary of State ❑ ❑ 0 Hazardous Waste Haulers Permit I Cal/EPA—DTSC ❑ El ® Industrial Activities Storm Water General Permit C A—SWRCB ❑ ❑ ' ® Non-Profit Organization 501 (C) (3) Ca. Secretary of State El I El Prop. 65 Safe Drinking Water&Toxic Enforcement Act 1 Cal/EPA—OEHHA I j ❑ ❑ ® Solid Waste Facilities Permit I Cal/EPA—CIWMB ® ❑ ! ❑ State EPA Identification Number Cal/EPA—DTSC i ® ❑ ❑ Waste and Used Tire Hauler Registration Cal/EPA—CIWMB ❑ ❑ ® Waste Discharge Requirements Cal/EPA—SWRCB ❑ ❑ ❑ Waste Tire Facilities Permit Cal/EPA—CIWMB ® ❑ El US EPA—Identification Number US EPA ® ❑ ❑ US EPA—NPDES and/or NSR Permits i US EPA a 'I ❑ ❑ ❑ ❑ Ei ❑ ❑ ❑ 1 ❑ ❑ ' DO NOT submit copies of the permits/licenses/filings with this form. Please retain all permits/licenses/filings in grant file for audit purposes. omments/Notes: I i Mark(�/or X)appropriate box below. PRIVATE ENTITY CERTIFICATION: I declare under penalty of perjury under the laws of the State of California that the proposed grantee: 1) is in good standing and qualified to do business in the State; and 2) has or will comply with all applicable state, federal, and local laws, ordinances, regulations, license and permit requirements necessary for the proper performance of this grant; and 3)where compliance has not been met, I have attached a letter describing what has been done to achieve full compliance. PUBLIC ENTITY CERTIFICATION: I declare under penalty of perjury under the laws of the State of California that the proposed grantee: 1) has or will comply with all applicable state, ® federal, and local laws, ordinances, regulations, license and permit requirements necessary for the proper performance of this grant; and 2)where compliance has not been met, have attached i a letter describing what has been done to achieve full compliance. Executed at: San Bernardino, CA on 2-16-11 City and State Date X 104r-X_ Signature Authority I A horized Designee Date i (as authorized in Resolution or Letter of Designation-LOD) I Nadeem Majaj Director of Public Works Print Name Print Title Note: Falsification under penalty ofperjury may result in criminal and civil penalties.In addition,pursuant to the terms of the grant agreement, any misrepresentations in the above certification shall constitute a breach of contract that could result in non-payment of grant funds to the grantee;relinquishment by the grantee of funds previously paid; termination of the grant;and/or placing the grantee on CalRecycle's Unreliable Contractor's List. STATE OF CALIFORNIA DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY(CalRecycle) GRANT APPLICATION FORM CalRecycle 243-TCA(Revised 12/10) APPLICATION CHECKLIST This application checklist is provided for your convenience and is not intended to be all inclusive.Prior to submitting your application,check the Q&A website at hi!p://www.calrecycle.ca.gov/tires/Grants/CleanLip/FY20101 I/Apply/�QandA.htin for additional information. You are responsible for com2leting and submitting all re uired documentation. ® All applicable information and documents are provided;applicable boxes are checked. ® Application Certification is signed by the: 1) Signature Authority as authorized in Resolution,or 2)Authorized Designee. Authorized Designee may sign only if the Letter of Designation has been submitted to CalRecycle. ® A registered waste tire hauler quote is included. ® Photo for waste tire cleanup project is included. ❑ If applicable,Property Access Authorization and Responsibility Affidavit For Private Property is included. See Application Guidelines&Instructions for more information. ® Box is checked. �, ❑ Approved Resolution is included with Application;box is checked,or I ® If applicable,approved Resolution not submitted with Application but will be submitted to CalRecycle for receipt by March 18,2011; box is checked. ❑ If applicable,Letter of Designation(LOD)is included with Application. A LOD is not required to be submitted with the Application;however, it must be submitted prior to Designee's exercise of his/her authority. i ❑ Signature Authority has certified that Applicant has an Environmentally Preferable Purchases and I Practices Policy(EPPP Policy);box is checked,or _ I ® I Applicant does not have an EPPP Policy but will adopt one by March 18,2011 and submit a Notification to the CalRecycle for receipt by March 18,2011;box is checked. ® CIWMB 669 form is completed. ® Box is checked. ® Copies: One application with original signature(blue ink preferred), and two copies ® Paper: 8'/2 X 11,printed double-sided,single spaced,on 100%post consumer fiber,and numbered consecutively ® Stapled,not bound: upper left-hand corner ® Font: Comparable to 12 pt.Times New Roman ® I Addressed to the appropriate mailing address of CalRecycle . ,. .... .,... �.� `2 a, c ffi ycl December 2010 Natural Resources Agency Department of Resources Recycling and Recovery (CalRecycle) LOCAL GOVERNMENT WASTE TIRE CLEANUP AND AMNESTY EVENT GRANT PROGRAMS APPLICATION TCA8 Cycle - FISCAL YEAR (FY) 2010/11 Page GrantApplication Form................................................................................................................................2 Environmental Justice Certification..............................................................................................................2 ResolutionRequirement........................................................................................................................... ....3 Environmentally Preferable Purchases and Practices Policy Requirement...................................................3 Acceptanceof Grant Provisions....................................................................................................................3 ApplicationCertification...............................................................................................................................3 Waste Tire Cleanup Project(s)Description...................................................................................................4 Waste Tire Amnesty Event(s)Description....................................................................................................4 Work Plan Waste Tire Cleanup Projects 5 Work Plan(Waste Tire Amnesty Events).....................................................................................................6 Budget(Waste Tire Cleanup Projects)..........................................................................................................7 Budget Waste Tire Amnesty Events 8 General Checklist of Business Permits,Licenses and Filings.......................................................................9 ApplicationChecklist..................................................................................................................................11 Mailed applications must be postmarked no later than February 18,2011. Hand delivered applications must be received and date stamped by CalRecycle Staff no later than 3:00 p.m.on February 18,2011. Late applications will be disqualified. Emailed or faxed applications will not be accepted. Please follow instructions in the Application Guidelines and Instructions when completing this application. The Application Guidelines and Instructions are critical to properly completing and submitting this application. Applications become the property of CalRecycle and are subject to disclosure under the Public Records Act. Do not submit confidential information. Applications sent by U.S. Postal Service or a commercial delivery service should be sent in a manner that allows for tracking by the sender and that provides an addressed and dated receipt. Failure to do so is at the risk of the applicant and if delivery is delayed or the application is lost by the Post Office or delivery service, the burden is on the applicant to demonstrate timely mailing or delivery of the application. STATE OF CALIFORNIA DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY(CalRecycle) GRANT APPLICATION FORM CalRecycle 243-TCA(Revised 12/10) LOCAL GOVERNMENT WASTE TIRE CLEANUP AND AMNESTY EVENT GRANT PROGRAMS —TCA8 (FY 2010/11) Complete and submit all sections. APPLICANT/ORGANIZATION NAME(MUST MATCH RESOLUTION): CLEANUP PROJECTS 20000 AMOUNT: City of San Bernardino AMNESTY EVENTS PARTICIPATING JURISDICTIONS(FOR REGIONAL PROGRAMS ONLY): s AMOUNT: r REQUESTED TOTAL AMOUNT: 20000 I (ROUND AMOUNTS TO THE NEAREST WHOLE DOLLAR) MAILING ADDRESS: PROJECT ADDRESS: 300 North D Street CITY: CITY: San Bernardino COUNTY: ZIP CODE: COUNTY: ZIP CODE: San Bernardino 92418 PRIMARY CONTACT NAME: SIGNATURE AUTHORITY NAME: AUTHORIZED DESIGNEE NAME: (IF APPLICABLE,AS AUTHORIZED IN LETTER OF DESIGNATION- (AS AUTHORIZED IN RESOLUTION LO D,SEE APPENDIX A FOR MORE INFO.) Deborah Allen Charles McNeely Nadeem Maja' TITLE' TITLE: TITLE: Environmental Projects Manager City Manage. of Public Works TELEPHONE NUMBER: TELEPHONE NUMBER: TELEPHONE NUMBER: 909-384-5549 909-384-5122 909-384-5140 FAX NUMBER: FAX NUMBER: FAX NUMBER: 909-384-5190 909-384-5138 909-384-5190 EMAIL ADDRESS: EMAIL ADDRESS.' EMAIL ADDRESS: allen de sbcit .or mcneel ch sbcit .or majaj_na@sbcity.org rN�D�ICATE WHICH TYPE OF ENTITY YOU ARE(CHECK ONLY ONE): ®CITY ❑COUNTY ❑CITY&COUNTY ❑QUALIFYING INDIAN TRIBE ❑OTHER(LIST TYPE) LEGISLATIVE DISTRICT NUMBERS (TO FIND YOUR DISTRICT, USE MAILING ADDRESS ABOVE AND GO TO www.calrecycle.ca.gov/Profiles/Juri FEDERAL TAX IDENTIFICATION NUMBER: ASSEMBLY: SENATE: 62 32 95-6000772 i CalRecycle Grantees must in the performance of the Grant Agreement conduct their programs,policies, and activities that substantially affect human health or the environment in a manner that ensures the fair treatment of people of all races, cultures, and income levels, including minority populations and low-income populations of the State. (Govt. Code§65040.12(e)and Public Resources Code§71110(a)) ® We acknowledge that our organization will comply with these principles of Environmental Justice. Local Government Waste Tire Cleanup and Amnesty Event Grant Programs,TCA8(FY 2010/11) 2 STATE OF CALIFORNIA DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY(CalRecycle) GRANT APPLICATION FORM CalRecycle 243-TCA(Revised 12/10) Submit either an approved Resolution,valid up to 5 years,with your application or the following acknowledgement. (If applicable,submit a current Letter of Designation(LOD)for signature designee) j Note:All previous approved multryear Resolutions must be updated to include new Department name.See Application Guidelines&Instructions or Resolution and Letter of Designation(LOD)information and examples. ❑ We acknowledge that an approved Resolution and, if applicable,LOD designating additional signature authority is enclosed in the application. I We acknowledge that our approved Resolution must be received by CalRecycle no later than i ® March 18,2011. We further acknowledge that if our Resolution is received after this date, our application will be disqualified. Environmentally preferable purchasing protects human health and environmental well-being by reducing the procurement of goods and services that result in larger volumes of waste and pollutants. The Legislature declares that the responsibility of environmentally preferable purchasing shall be that of any agency that does procuring on I behalf of the state (Chan, Statutes of 2002, Chapter 575), and this extends to grantees using state funds. "Environmentally preferable purchasing(EPP)"as defined in PCC section 12400 means "the procurement or acquisition ofgoods and services that have a lesser or reduced effect on human health and the environment when 1 compared with competing goods or services that serve the same purpose. This comparison shall take into consideration, to the extent feasible, raw materials acquisition,production, manufacturing,packaging, distribution, j -euse, operation, maintenance, disposal, energy efficiency,product performance, durability, safety, the needs of the urchaser, and cost." In other words, EPP considers, among other things, the environment,performance and cost." Yes,our entire organization' has an Environmentally Preferable Purchasing and Practices ❑ Policy. Date adopted: No,our entire organization does not have an Environmentally Preferable Purchasing and ® Practices Policy. We acknowledge that our organization must adopt one by March 18,2011 and send notification to the CalRecycle of such adoption by secondary deadline;March 18, j 2011,or our application will be disqualified. By checking this box,Applicant acknowledges that submittal of this application constitutes ® acceptance of all Grant Agreement provisions as contained in the Terms and Conditions and t Procedures and Requirements.To download these documents see: h=://www. alrec cle.ca. ov/tires/Grants/Cleanu /FY201011/default.ht3n Certffication:I declare, under penalty of perjury under the laws of the State of California, that/have read all information in the Application Guidelines and Instructions and that all information submitted for the CalRec I 's consideration for award of grant funds is true and correct to the best of my knowledge. i ��// X /7 7 02 Z/ _/// 1 Signature Authority-as dualorized in Resolution or Letter of Commitment;or jute j Authorized Designee-as authorized in submitted Letter of Designation adeem Majaj Director of Public Works Print Name Print Title "Entire organization" refers to the entire city, county or non-profit applicant, not an individual office or subunit of the larger entity. Local Government Waste Tire Cleanup and Amnesty Event Grant Programs,TCA8(FY 2010/11) 3 STATE OF CALIFORNIA DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY(CalRecycle) GRANT APPLICATION FORM CalRecycle 243-TCA(Revised 12/10) Provide the location,parcel number and a description of each site,which includes proximity to populated areas or sensitive environments,number of tires,proposed method of remediation,and end use.Photographs should also be included. Please include a quote from a registered waste tire hauler to justify the estimated cost per tire.If there are more than 500 tires on private property and the owner is not responsible for the illegal disposal of the tires,then an affidavit for each site must be included with the application. See Application Guidelines and Instructions for the affidavit form. See attachments How many tires are estimated to be removed:2750 Will these tires be recycled or landfilled? recycled Is the applicant able to utilize the California Conservation Corps or Local Community Conservation Corps for tire removal?not currently Provide a description of the amnesty event(s),including the estimated cost per tire for each event(grant amount divided by number of tires to be collected). Please include a quote from a registered waste tire hauler to justify the estimated cost per tire. NA How many tires are estimated to be removed: NA Will these tires be recycled or landfilled? NA is the applicant able to utilize the California Conservation Corps or Local Community Conservation Corps for tire removal? NA Local Government Waste Tire Cleanup and Amnesty Event Grant Programs,TCA8(FY 2010/11) 4 I � i 0 k CV \ \ 2 � � \ G G � R u w ( § cn k ° \ 2 k m m « e § q § f Q 0 / j IL $ r j G \ T 0 / 7 0 j j \y e CL F 0 2 2 � E e P Lo 2 § w o o 04 Z) > .7 7 § w \L LL \ § [ z C \ b Cl L LU L $ \ � 2 U. _ 7 cc 2 � O ) d f - ƒ L.w � > z \ / m _ \ z % a c « e \ A Q \ k4 \ C CD e ® hz « /0 / � / } q — U) o 0 L) � e z > - w \ & \ w Z \ a � / 0 U ; z 2 K � ƒ \ § � � \ \ 2 / / Wiz ƒ ) k2 U) > CN > y k R S @ 0 \ k / z 2 \ � a � \ k � \ CD [ � < � Cl. O \ 2d u \ Oa I e < P CC z Q e z ) 0 \� . IL k D Z « ' / 0 { < of J 3 noo % \ { ( S R Cl \ / \ @ C14 : I--: \ � 0 L) w ° z o CL o / / � , » % J \ U \ a. § x / ® a r LLJ z: ` ® q k\ / &2 % 2X � � \ Mz \ w / z :\ \\ o § w O & \ % 0 > ) ` ^ \ w § q / kF @ \ k \ \ k k \ E i 0_ CL o 0- k CL cn @R k k \ C) 3 3 z } \ \ L k / / = f 0 \ { \ v Cl) / [O/ o R � §� ) § D w 7 f k $ : o / 7� k e a I � _ � z 0 E q 2 k / � _ - § w , ® [CD � R « « 2 � $ f ° § W < � z � fo » k 3 � � \ \ � 25 / wk k 2 a § Q \ a � \ \ E \/ o \� \ / ® z `\ ~ w , 2 > 2 - ° \ ƒ e o I ■ \ � § \ « k o w \ § � E 7 \ o \ 4) ® � z § o � w 3 w ■ [ 2 g ° w \% w § { } % b � \ U- a \ 2 » � s ca a b E E ; 2 g g g 9 } \ [ . / ) k k ° 3 3 (D 3 \ £ LL / I } o ) \ \ @ \ % ¥ \ CL O & CL \ U- o § Z b E § CY) f O $ ® _ < « k> 7 @ «\ c e >c ® ° (( ~ \ f § E 0 CL a < /\ \ Q) ; § k4 n- \ �� � � cn 2 ® c \ ƒ [ L) @ cn g ?) o 4) § 2 � z � � § � � � 0 k / \ ? e « ; ` o @ £ 5 \ ' c ca § \ \ 3 k w k 3 / ƒ t \ | STATE OF CALIFORNIA DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY(CalRecycle) 3ENERAL CHECKLIST OF BUSINESS PERMITS, LICENSES AND FILINGS ,alRecycle 669(Rev.01/10)) GRANT APPLICANT/GRANTEE NAME City of San Bernardino GRANT NAME AND CYCLE GRANT NUMBER,IF APPLICABLE DATE SUBMITTED/UPDATED Waste Tire Cleanup/Amnesty Grant Program TCA8 12-8-11 Mark(✓or X)appropriate box on each line below. All lines must be completed. Note: This list is not all-inclusive. Grant Applicant/Grantee must list other critical permits/licenses/filings not identified below. Grant Applicant/Grantee currently holds this valid permit/license/filing Grant Applicant/Grantee will modify and/or obtain this permit/license/filing This permit/license/filing is not applicable for this grant project or business i P0 ❑ ❑ 0 Authority to Construct/Permit to Operate Air Quality Management District ❑ 1 ❑ ® Building Construction Permit City or County ❑ ❑ Business License City or County ❑ ❑ Fictitious Business Name Filing County ❑ , El Land Use Permit/Zoning Clearance/Conditional Use Permit City or County Permit By Rule(PBR)for Permanent HHW Facilities or Temporary ❑ El ® Collection Events City, County or Cal/EPA-DTSC ® ❑ ❑ Waste Hauler Permit City or County s, ❑ ❑ Antifreeze, Battery, Oil& Paint(ABOP) Notification CUPA or CaUEPA-DTSC ❑ ❑ 0 Corporate, Company or Partnership Filings Ca. Secretary of State ❑ ❑ ® Hazardous Waste Haulers Permit Cal/EPA—DTSC "S 101 ® Industrial Activities Storm Water General Permit Cal/EPA—SWRCB ❑ ® Non-Profit Organization 501 (C)(3) Ca. Secretary of State ❑ ❑ I Prop. 65 Safe Drinking Water&Toxic Enforcement Act Cal/EPA—OEHHA ❑ I ❑ ® Solid Waste Facilities Permit Cal/EPA—CIWMB ® ❑ ❑ State EPA Identification Number Cal/EPA—DTSC ® ❑ ❑ Waste and Used Tire Hauler Registration Cal/EPA—CIWMB ❑ ❑ 0 Waste Discharge Requirements Cal/EPA—SWRCB ❑ ❑ 0 Waste Tire Facilities Permit Cal/EPA—CIWMB a. ® Cl ❑ I US EPA—Identification Number US EPA ® ❑ ❑ US EPA—NPDES and/or NSR Permits US EPA I ❑ ❑ ❑ ❑ ❑ El 1 ❑ ❑ .jO NOT submit copies of the permits/licenses/filings with this form. Please retain all permits/licenses/filings in grant file for audit purposes. Commentsvotes. C1 Mark(✓or X) appropriate box below. PRIVATE ENTITY CERTIFICATION: I declare under penalty of perjury under the laws of the I State of California that the proposed grantee: 1) is in good standing and qualified to do business in the State; and 2) has or will comply with all applicable state, federal, and local laws, ordinances, regulations, license and permit requirements necessary for the proper performance of this grant; and 3)where compliance has not been met, I have attached a letter describing what has been done to achieve full compliance. PUBLIC ENTITY CERTIFICATION: I declare under penalty of perjury under the laws of the State of California that the proposed grantee: 1) has or will comply with all applicable state, ® federal, and local laws, ordinances, regulations, license and permit requirements necessary for the proper performance of this grant; and 2)where compliance has not been met, have attached j a letter describing what has been done to achieve full compliance. Executed at: San Bernardino, CA on 2-16-11 City and State Date Signature Authority/A thorized Designee Date (as authorized in Resolution or Letter of Designation-LOD) Nadeem Majaj _ Director of Public Works Print Name Print Title Note: Falsification under penalty ofperjury may result in criminal and civil penalties.In addition,pursuant to the terms of the grant agreement, any misrepresentations in the above certification shall constitute a breach of contract that could result in non-payment ofgrant funds to the grantee;relinquishment by the grantee of funds previously paid; termination of the grant;and/or placing the grantee on CalRecycle's Unreliable Contractor's List. STATE OF CALIFORNIA DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY(CalRecycle) GRANT APPLICATION FORM CalRecycle 243-TCA(Revised 12110) APPLICATION CHECKLIST This application checklist is provided for your convenience and is not intended to be all inclusive.Prior to submitting your application,check the Q&A website at http://www.calrecycle.ca.gov/tires/Grants/Cleanup/FY201011/Apply/QandA.htm for additional information. You are res onsible for completing and submittin all require documentation. �a ® All applicable information and documents are provided;applicable boxes are checked. ® Application Certification is signed by the: 1) Signature Authority as authorized in Resolution,or 2)Authorized Designee. Authorized Designee may sign only if the Letter of Designation has been submitted to CalRecycle. ® A registered waste tire hauler quote is included. ® Photo for waste tire cleanup project is included. ❑ 1 If applicable,Property Access Authorization and Responsibility Affidavit For Private Property is included. See Application Guidelines&Instructions for more information. ® Box is checked. 0 ❑ Approved Resolution is included with Application;box is checked,or ® If applicable,approved Resolution not submitted with Application but will be submitted to CalRecycle for receipt by March 18,2011;box is checked. i i If applicable,Letter of Designation(LOD)is included with Application. A LOD is not required to be submitted with the Application;however, it must be submitted prior to Desi ee's exercise o his/her authority. ❑ Signature Authority has certified that Applicant has an Environmentally Preferable Purchases and Practices Policy(EPPP Policy); box is checked,or ® Applicant does not have an EPPP Policy but will adopt one by March 18,2011 and submit a Notification to the CalRecycle for receipt by March 18,2011;box is checked. ® CIWMB 669 form is completed. Box is checked. ® Copies:One application with original signature(blue ink preferred),and two copies ® Paper: 8'/z X 11,printed double-sided,single spaced,on 100%post consumer fiber,and numbered consecutively ® Stapled,not bound: upper left-hand corner ® Font: Comparable to 12 pt.Times New Roman Addressed to the appropriate mailing address of CalRecycle Local Government Waste Tire Cleanup and Amnesty Event Grant Programs,TCA8(FY 2010/11) 11 EXHIBIT A Cai Recycle December 2010 Natural Resources Agency Department of Resources Recycling and Recovery (CalRecycle) LOCAL GOVERNMENT WASTE TIRE CLEANUP AND AMNESTY EVENT GRANT PROGRAMS APPLICATION TCA8 Cycle - FISCAL YEAR (FY) 2010/11 page GrantApplication Form................................................................................................................................2 Environmental Justice Certification..............................................................................................................2 ResolutionRequirement................................................................................................................................3 Environmentally Preferable Purchases and Practices Policy Requirement...................................................3 Acceptance of Grant Provisions....................................................................................................................3 ApplicationCertification...............................................................................................................................3 Waste Tire Cleanup Project(s)Description...................................................................................................4 Waste Tire Amnesty Event(s)Description....................................................................................................4 Work Plan(Waste Tire Cleanup Projects)....................................................................................................5 Work Plan(Waste Tire Amnesty Events).....................................................................................................6 Budget Waste Tire Cleanup Projects) ..................................................................•7 Budget(Waste Tire Amnesty Events)...........................................................................................................8 General Checklist of Business Permits,Licenses and Filings.......................................................................9 ApplicationChecklist..................................................................................................................................I 1 Mailed applications must be postmarked no later than February 18,2011. Hand delivered applications must be received and date stamped by CalRecycle Staff no later than 3:00 p.m. on February 18,2011. Late applications will be disqualified. Emailed or faxed applications will not be accepted. Please follow instructions in the Application Guidelines and Instructions when completing this application. The Application Guidelines and Instructions are critical to properly completing and submitting this application. Applications become the property of CalRecycle and are subject to disclosure under the Public Records Act. Do not submit confidential information. Applications sent by U.S Postal Service or a commercial delivery service should be sent in a manner that allows for tracking by the sender and that provides an addressed and dated receipt. Failure to do so is at the risk of the applicant and if delivery is delayed or the application is lost by the Post Wce or delivery service, the burden is on the applicant to demonstrate timely mailing or delivery of the application. STATE OF CALIFORNIA DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY(CalRecycle) GRANT APPLICATION FORM CalRecycle 243-TCA(Revised 12/10) LOCAL GOVERNMENT WASTE TIRE CLEANUP AND AMNESTY EVENT GRANT PROGRAMS —TCA8 (FY 2010/11) Com lete and submit all sections. APPLICANT/ORGANIZATION INFORMATION APPLICANT/ORGANIZATION NAME(MUST MATCH RESOLUTION): CLEANUP PROJECTS 20000 AMOUNT: City of San Bernardino AMNESTY EVENTS PARTICIPATING JURISDICTIONS(FOR REGIONAL PROGRAMS ONLY): AMOUNT: REQUESTED TOTAL AMOUNT: 20000 (ROUND AMOUNTS TO THE NEAREST WHOLE DOLLAR) MAILING ADDRESS: PROJECT ADDRESS: 300 North D Street _ CITY: CITY: j San Bernardino —_ COUNTY: i ZIP CODE: COUNTY: ZIP CODE: San Bernardino 92418 PRIMARY CONTACT NAME: SIGNATURE AUTHORITY NAME: AUTHORIZED DESIGNEE NAME: (AS AUTHORIZED IN RESOLUTION) (IF APPLICABLE,AS AUTHORIZED IN LETTER OF DESIGNATION- LOD,SEE APPENDIX A FOR MORE INFO.) Deborah Allen Charles M_c_Neely Nadeem Majaj TITLE TITLE: — TITLE: Environmental Projects Manager City Manager Director of Public Works TELEPHONE NUMBER: TELEPHONE NUMBER: TELEPHONE NUMBER: 909-384-5549 _ 909-384-5122— 909-384-5140 FAX NUMBER: FAX NUMBER: FAX NUMBER: 909-384-5190 _ _ 909-384-5138_ 909-384-5190 EMAIL ADDRESS: i EMAIL ADDRESS: EMAIL ADDRESS: alien de sbcit .or mcneel ch sbcit .or maja' na@sbcity.org INDICATE WHICH TYPE OF ENTITY YOU ARE(CHECK ONLY ONE): ®CITY ❑COUNTY ❑CITY&COUNTY ❑QUALIFYING INDIAN TRIBE ❑OTHER(LIST TYPE) _ LEGISLATIVE DISTRICT NUMBERS (TO FIND YOUR DISTRICT, USE MAILING ADDRESS ABOVE AND GO TO www.calrecycle.ca.gov/Profiles/Juris/) FEDERAL TAX IDENTIFICATION NUMBER: lASSEMBLY: SENATE: 62 32 95-6000772 CalRecycle Grantees must in the performance of the Grant Agreement conduct their programs,policies, and activities that substantially affect human health or the environment in a manner that ensures the fair treatment of people of all races, cultures, and income levels, including minority populations and low-income populations of the State. (Govt. Code§65040.12(e)and Public Resources Code§71110(a)) ® We acknowledge that our organization will comply with these principles of Environmental Justice. Local Government Waste Tire Cleanup and Amnesty Event Grant Programs,TCA8(FY 2010/11) 2 STATE OF CALIFORNIA DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY(CalRecycle) GRANT APPLICATION FORM *�Prov!de le 243-TCA(Revised 12/10) iW the location,parcel number and a description of each site,which includes proximity to populated areas or sensitve environments,number of tires,proposed method of remediation,and end use.Photographs should also be included. Please include a quote from a registered waste tire hauler to justify the estimated cost per tire.If there are more than 500 tires on private property and the owner is not responsible for the illegal disposal of the tires,then an affidavit for each site must be included with the application. See Application Guidelines and Instructions for the affidavit form. See attachments How many tires are estimated to be removed: 2750 Will these tires be recycled or landfilled? recycled Is the applicant able to utilize the California Conservation Corps or Local Community Conservation Corps for tire -removal?not currently ��; ���� � �� � �lli'' ►ST�;�"�I�t��Al11�IV�5 � � ,A.ES� � O :� 4 ��, Provide a description of the amnesty event(s),including the estimated cost per tire for each event(grant amount divided by number of tires to be collected). Please include a quote from a registered waste tire hauler to justify the estimated cost per tire. NA How many tires are estimated to be removed: NA Will these tires be recycled or landfilled? NA Is the applicant able to utilize the California Conservation Corps or Local Community Conservation Corps for tire removal?NA Local Government Waste Tire Cleanup and Amnesty Event Grant Programs,TCA8(FY 2010/11) 4 A ) N m \ `N N n :3 > < < y . O w : \ C . / w \ \ § / ° \ z z « e »<_ § -i S \§ \O O o 0 o §S } CL% ? :y . P 2 . :■. / § \ k \\ < \ E § IL 2 \ \ 0 z� J CD U � 2G R a d ° ° § D j ; E S j \ a a OD � b E / \ . � LL \ \ . » 2 + [ 'a » d E % O \Z 0 -0 2 L o p \ \5 f < g ) z ^: / ¥ 2 E�\ z � \7 4) ) o , \ co }p / k / . E � %I . k } § k b U)oo o O m �\ } / a « �}�\ I »\ \ � � z w 2 _ (D f z i \ LLJ < / o w ] ■ T w / § U) � 0 \ k � w U) Q w § D » § j \ / o v \ § } k § k \ D 3 � - : / ca s LL /} ) z � E % O2 I ¥ < ) � k \ 0 <1 k u g ® K L) ep < § A2 � e A \ � / z - o / / j G 0 0 0 �1, o � o0 00 C) C) o N � F � L � d N �. d W O U O J O Q U p W Z 3 I^ O � T I V LO CL N f0 co w U z N W , a LLJ w V o Q. U LLI msr` X 'C a) � C V Z W o O d Hz a� C ++ N N a U QJ ti N LO Q ° N `- X II Mo 0 U m Z M z �+ w LV � Efl O N � O d _ O O o U Z U v3 C N R' C14 � W 3 e r O 7 r- a) d En ti O o m >, ca P co U' AFL M U E U Z O Q4 r, C .0 U C C w ~ O x O (9 N O O m m U C J Q a tc6n r d o �;Qk E a c _ °a (n � a 7� ` a� a) a� a 'o ca cn U w 0 H 0 0 0 Z C7 O N >,e ; a) > 7 w (6 y C Y c ,. OO tC cu a > m o O 3 OL 5 � O Z U. � U (D c'o w ;SJ a' C ca N C d CD c O N O O CD z �r > Q (0 o w U Zr�s, O N Q C Q , O Q Q C F' N OJU U Ti a) a) U) L CD d " c Z >i f- 0! Cl) ��cu - d U FW- Q Z N C Q O -� ca iC7U U` C) 5 �. w r L Q) L q• i s cti 7 � s� w 4- _ O ~ N Z W O W co T O XI'r u p m W '� �:,= co > Z � w Q W O w .0 d of ~ Z rr N W Oy N ti. ) m w .• ff ► o W _a � r�If s" W T N w � O D O C/) L}L O Q a ' O m � Q H O U Z- N F- O E Z J C C C C m ca r t O O O O y o Q T y a O N N h cn W C7 p } O O O N U. U >. co to c $t C E O O Q co c 0 O a O o cp cc LL N ` N # U N _O N w. N H Z �O cu > c}o Q > m Z O Q O ^ U U N E N O Q p>C C w 06 oe$ Q> > E a. C p) O p) C C :' O d O U cn C N O O O E LL Q N �- U co co :. +, w > ZT a� ' � N ` co v � ° LLJ O' O J a � Q Z 4 ;', d 0` O N '� O O V O O a c � .. 1 c N f a` v O U) co '0 v U)C7 U (D U iE5 W W Q3 STATE OF CALIFORNIA DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY(CalRecycle) GENERAL CHECKLIST OF BUSINESS PERMITS, LICENSES AND FILINGS 'alRecycle 669(Rev.01/10)) GRANT APPLICANT/GRANTEE NAME City of San Bernardino GRANT NAME AND CYCLE I GRANT NUMBER,IF APPLICABLE DATE SUBMITTED/UPDATED Waste Tire Cleanup/Amnesty Grant Program I TCA8 2-8-11 Mark(✓or X)appropriate box on each line below. All lines must be completed. Note: This list is not all-inclusive. Grant ApplicantfGrantee must list other critical permitsRicensesffilings not identified below. Grant ApplicantlGrantee currently holds this valid permit/licensefling — Grant Applicant/Grantee will modify and/or obtain this permit/license/filing I This permit/license/filing is not applicable for this grant project or business LOCAL PERMITS,LICENSES&FILINGS r — REGULATOR OR ISSUER El El ® Authority to Construct/Permit to Operate Air Quality Management District ❑ ❑ ® Building Construction Permit City or County ❑ ❑ ® Business License City or County ❑ ❑ ® Fictitious Business Name Filing County ❑ ❑ ® Land Use Permit/Zoning Clearance/Conditional Use Permit City or County ❑ ❑ ® Permit By Rule(PBR)for Permanent HHW Facilities or Temporary City, County or Cal/EPA-DTSC Collection Events ® ❑ ❑ Waste Hauler Permit City or County STATE PERMITS,LICENSES&FILINGS ❑ ® Antifreeze, Battery,Oil&Paint(ABOP)Notification CUPA or Cal/EPA-DTSC ❑ ❑ ® Corporate, Company or Partnership Filings _� Ca. Secretary of State El Hazardous Waste Haulers Permit — Cal/EPA–DTSC ❑ ❑ ® Industrial Activities Storm Water General Permit Cal/EPA–SWRCB ❑ ❑ ® Non-Profit Organization 501 (C)(3) Ca. Secretary of State ❑ ❑ ® Prop. 65 Safe Drinking Water&Toxic Enforcement Act Cal/EPA–OEHHA ❑ ❑ ® Solid Waste Facilities Permit Cal/EPA–CIWMB ® ❑ ❑ State EPA Identification Number Cal/EPA–DTSC ® ❑ ❑ Waste and Used Tire Hauler Registration Cal/EPA–CIWMB ❑ ❑ ® Waste Discharge Requirements Cal/EPA–SWRCB ❑ ❑ ® Waste Tire Facilities Permit �— — Cal/EPA–CIWMB FEDERAL PERMITS,LICENSES&FILINGS ® ❑ ❑ US EPA–Identification Number _ US EPA _ E ❑ ❑ US EPA–NPDES and/or NSR Permits US EPA _ OTHER PERMITS,LICENSES&FILINGS El 11 MO ❑ ❑ NOT submit copies of the permits/licenses/filings with this form. Please retain all permits/licenses/filings in grant file for audit urposes. I nral rnvPmment WastP Tire CIPanUD and Amnestv Event Grant Proarams,TCA8(FY 2010/11) 9