Form CalRecycle217 "Financial Assurance Mechanism Review Request" - California

What Is Form CalRecycle217?

This is a legal form that was released by the California Department of Resources Recycling and Recovery - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2017;
  • The latest edition provided by the California Department of Resources Recycling and Recovery;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CalRecycle217 by clicking the link below or browse more documents and templates provided by the California Department of Resources Recycling and Recovery.

ADVERTISEMENT
ADVERTISEMENT

Download Form CalRecycle217 "Financial Assurance Mechanism Review Request" - California

773 times
Rate (4.5 / 5) 46 votes
State of California • Department of Resources Recycling and Recovery
Financial Assurance Mechanism Review Request
CalRecycle 217 (Revised 01/17)
Requestor and Date Information
Name:
Organization:
Email:
Phone Number:
Date of Request:
Date Needed By (minimum of 30 days from request):
Applicable Review Clock Closing Date:
Facility Information
Type of Facility: Choose an item.
Major Waste Tire Facility
Permit Action: Choose an item.
Permit for Expansion
Plan (If the plan is for less than the entire site, please provide an explanation in the Comments section.):
Closure/Postclosure Plan: Choose an item.
Not applicable
Corrective Action Plan: Choose an item.
Not applicable
Facility Name:
Solid Waste Information System (SWIS) Number:
County:
Facility Address:
Street:
City
State
ZIP Code:
Operator Name:
Owner Name:
Facility Contact:
Name:
Phone Number:
Email:
Closure and Postclosure Maintenance Cost Estimates
Closure Cost Estimate: $
Date of Plan or Revision to Plan:
Annual Postclosure Cost Estimate: $
Date of Plan or Revision to Plan:
Anticipated Closure Date:
Closure Certification Date:
Corrective Action Cost Estimate
Type of Corrective Action: Choose an item.
Non-water Corrective Action
Cost Estimate: $
Date of Plan or Revision to Plan:
Comments
State of California • Department of Resources Recycling and Recovery
Financial Assurance Mechanism Review Request
CalRecycle 217 (Revised 01/17)
Requestor and Date Information
Name:
Organization:
Email:
Phone Number:
Date of Request:
Date Needed By (minimum of 30 days from request):
Applicable Review Clock Closing Date:
Facility Information
Type of Facility: Choose an item.
Major Waste Tire Facility
Permit Action: Choose an item.
Permit for Expansion
Plan (If the plan is for less than the entire site, please provide an explanation in the Comments section.):
Closure/Postclosure Plan: Choose an item.
Not applicable
Corrective Action Plan: Choose an item.
Not applicable
Facility Name:
Solid Waste Information System (SWIS) Number:
County:
Facility Address:
Street:
City
State
ZIP Code:
Operator Name:
Owner Name:
Facility Contact:
Name:
Phone Number:
Email:
Closure and Postclosure Maintenance Cost Estimates
Closure Cost Estimate: $
Date of Plan or Revision to Plan:
Annual Postclosure Cost Estimate: $
Date of Plan or Revision to Plan:
Anticipated Closure Date:
Closure Certification Date:
Corrective Action Cost Estimate
Type of Corrective Action: Choose an item.
Non-water Corrective Action
Cost Estimate: $
Date of Plan or Revision to Plan:
Comments