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a <br /> State of California Solid Aste Information System (SVA) California Integrated Waste <br /> CIWMB 37(Rev.01/2008) Facility/Site/Operation Data Entry Form Management Board <br /> E3*** New S WIS Number Z Update information(*❑ ) 0 Change in address or phone#s ❑ Request to Archive <br /> CIWMB USE ONLY Facility/Site/Operation SWIS Number 39 -AA - 0049 /LEA - <br /> }x see: littp://www.ciwmb.ca.gov/SW.IS[Miijimuml)ata.htm <br /> Facility/Site Name: Western Orqanics, Inc-Gro-Well Brands <br /> Facility/Site Location/Address: 4343 McKinley Ave., Stockton, CA 95206 <br /> Nearest City/Place Name: County: State_ Zip: - <br /> Facility locator info: Decimal Degrees=Longitude: - 111111. 111111 ❑ ❑ Latitude ❑ ❑. ❑ ❑ ❑ ❑ ❑ <br /> -or- Degrees,Minutes,and Seconds: Long: - Lat: <br /> Assessor Parcel Number(s):19302009 <br /> Map#: Section: Township: Range: Base/Meridian: <br /> x - <br /> Person/Operator Name/Company Name: Western Organics, Inc-Gro-Well Brands <br /> Last Name: Vega First Name: Jorge MI: <br /> Title: Plant Manager Organization:Western Organics, Inc-Gro-Well Brands <br /> Mailing Address: 4343 McKinley Ave <br /> City:Stockton State: CA Zip: �] ❑5 2 101 ©- ❑ ❑ ❑ ❑ <br /> Phone Number: (209 ) A ❑2 - ® ❑9 5 © FAX:(209 ) 9❑ [N F21- A ❑9 [I M <br /> E-Mail Address: ivega@gro-well.com <br /> Xt r. v .1111 a d ksc,� <br /> Person/Operator Name/Company Name: McKinely Way Properties, Inc <br /> Last Name: First Name: MI: <br /> Title: Organization: <br /> Mailing Address:P.O.Box 434 <br /> City: Ripon State: CA Zip: ❑5 © ©- ❑ ❑ ❑ ❑ <br /> Phone Number: (209 ) ❑9 A ❑2 - A ❑9 ❑3 © FAX:(209 > ❑9 ® [�fl- A M ❑3 M <br /> E-Mail Address: <br /> LEA or Operator or owner signature: X �� Phone: ��� 7� ate: �® �P <br /> ❑ Supporting documents attached ®Maps attached ®All signatures and dates present on documents <br /> See http:h"Nvkew.cmmb.ca.govlSWISIM infinum Data.litin <br /> ------------------------------------------------------------------------------------------------- ----------------- <br /> t <br /> Unit Activity(s) name(s)and Code#: <br /> (See back of this form for list of Activity types and codes) <br /> Check one each: <br /> Regulatory Status Onerator Tyne Operational Status Inspection Frequency: quarterly <br /> ❑Permitted ❑ Federal ❑Planned Closure year(date): <br /> ❑Unpermitted ❑ State ® Active TonsNolume per Day: 15 (peak loading) <br /> El Exempt ® County ❑Inactive Permit Date: <br /> ®EA Notification ❑City ❑Closed EA Notification date:6/8/09 <br /> ❑Excluded ❑Private ❑Clean Closed <br /> ❑Proposed ❑District ❑To be Determined <br /> List one or more Types of Waste to be received/permitted(see back of this form for list of waste types/code#) <br /> ***Required CIWMB staff Signature(Received and Reviewed for completeness) <br /> by: X Phone: Date: <br />