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State of California California Integrated Waste <br /> CIWMB 500(Rev. 10/02) Management Board <br /> WASTE TIRE FACILITY <br /> PERMIT APPLICATION <br /> I. TYPE OF APPLICATION (please print or type) SW IS#: <br /> New ❑ Permit ElPermit CIWMB use on_!y <br /> Permit Renewal Revision Dale Receirrd <br /> ❑ Application Dale Acce ted: <br /> Amendment _ Dafe Rejecled: <br /> II. TYPE OF FACILITY —� <br /> ❑ Existing x Proposed <br /> x Major Waste Tire Facility(5.000 or more tires) <br /> ❑ Minor Waste Tire Facility(500 or more tires,but less than 5,000) <br /> III. GENERAL INFORMATION <br /> Facility Name: Waste Recovery West, Inc. <br /> Facility Mailing Address: 4554 S.EI Dorado Street <br /> City: Stockton County: San Joaqiun State: CA Zip: 95206 Phone: <br /> Facility Location(if different from mailing address): <br /> City: County: State: Zip: Phone: <br /> Assessor's Parcel Number(s): 193-020-23 GPS Coordinates: Site Acreage: 7.49 <br /> Facility Operator's Name: Waste Recovery West,Inc. <br /> Mailing Address: P.O. Box 83328 <br /> City: Portland County: Multnomah State: OR Zip: 97283 Phone: 503-240-1919 <br /> Property Owner's Name(if different from operator): TDR Group,LLC dba Waste Recovery Group,LLC. <br /> Mailing Address: TP.O. Box 83478 <br /> City: Portland County: Multnomah State: OR I Zip: 1 97283 Phone: 503-781-7409 <br /> IV. AGENCY INFORMATION <br /> Fire Authority Agency Name: French Camp Fire Protection District <br /> Contact Person: John Gish Phone: 209-982-0592 <br /> Vector Control/Mosquito Abatement Agency Name: San Joaquin County Mosquito&Vector Control District <br /> Contact Person: John Stroh Phone: 1 (209)982-4675 _ <br /> V. TYPE AND QUANTITY OF WASTE TIRES <br /> x Whole Passenger x Whole Truck x Whole Tractor x Split Tires <br /> Type of Waste N Whole Earth mover/Constructio n Equipment x Cut Tires x Shredded Tires <br /> Tires Received: <br /> ❑ Other: <br /> Number of Waste Tires Stored or Maintained On-Site: 5,000 <br /> Maximum Capacity: 40,000 <br />