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LF7�I I IV/�E❑LD) <br /> State of California JUN 1 0 2009 <br /> CIWMB 169(Rev 4/04) California Integrated Waste <br /> ENFORCEMENT AGENC - LTH Management Board <br /> y1v W. <br /> ![Enforcement Agency: 11-SAN JOAQUIN C06_N_i�Y___ Official Use Only <br /> ---------- ENVIRONMENTAL HEALTH DEPT—. <br /> SWIS Number: <br /> County: 1 SAN JOAQUIN COUNTY <br /> Date Received, <br /> F_ <br /> I. GENERAL INFORMATION <br /> Operation Nam WESTERN ORGANICS, INC -GRO-WELL BRANDS CP INC <br /> i Address: 4343 MCKINLEY AVE. F_ <br /> Zip: <br /> Phone: 1 209-982-4936 City: I STOCKTON Site. J7 CA.. 95206 <br /> i I Fax: 1 209-982-4937 <br /> Operator Name: — <br /> WESTERN ORGANICS, INC-GRO-WELL BRANDS CP INC. <br /> Address: 4343 MCKINLEY AVE. <br /> - e <br /> Cit�. STC <br /> Phone:o n�,T <br /> _41— _ <br /> --City: 1 STOCKTON Ts_tate'j Zip.T95206 <br /> Phone: 209-982-4936 Fax: <br /> 209-982-4937 <br /> Land Owner: i MCKINLEY WAY PROPERTIES, INC <br /> Address. I P.O. BOX 434 City: RIPON State: <br /> Phone: 209-982-4936 '[ Fax: 09-982-4937 <br /> IL OPERATION INFORMATION LIMITED <br /> VOLUM <br /> Authorizing Eligibility(state section of 14 CCR Division 7,Chapter 3 or 3.1):See back for more details SECTION, 17403.3 TRANSFER I <br /> Type(s)of Waste/Material Handled- SHEETROCK OPERATION <br /> Volume of Waste/Material Handled: APPROX 10 TONS PER DAY <br /> Peak Loading: 15 TONS D Cubic Yards or <br /> — X Tons 1 Annual Loading., 2500 El Cubic Yards or Z Tons <br /> Days and Hours of Operation: <br /> 7:00 AM -4:00 PM M-F I Operation Acreage: 24 ACRES <br /> Brief Description of the Operation: 1 <br /> RECEIVING BULK SHEETROCK <br /> RELOADING & HAULING TO PROCESSON 114—STANISLAUS CO <br /> Ill. DOCUMENTATION OF LOCAL NOTIFICATION (check one and submit with EA Notification) <br /> :tlProof of Compliance with the California Environmental Quality Act(CEQA). <br /> Correspondence from the local planning department that compliance with <br /> CEQA is not required for the operation <br /> obtain locallanduse approval.❑ to <br /> Written notice to the local planning department of the operators intent to commence operations. <br /> IV. OWNER/OPERATOR CERTIFICATION <br /> I hereby certify under penalty of perjury that the information provided is true and accurate to the best of my knowledge and belief. <br /> Signature of Land Owner: <br /> Date: <br /> Signature of Operator: <br /> L Date. <br /> *Completion of this form is not required by reg ation-however,it will provide the enforcement agency with the information required by 14 CCR 18103.1. <br /> ired a Wj ,­,.r itiiinr i.+. <br /> A separate Notification is required for each eligible operation. <br />