Laserfiche WebLink
State of California S®i1IaVcilit3L/Site/Qveration <br /> ante Information System ( 1S) California Department of Resources <br /> CalRecycle 37(Rev.12/2012) Data Entry For Recycling and Recovery(CalRecycle) <br /> ❑*** New SWIS Number DqUpdate information(*❑ ) ❑Change in address or phone #s ❑Request to Archive <br /> CALRECYCLE USE ONLY=Facility/Site/Operation SWIS Number 39 - AA - 0054 /LEA - <br /> see: tt :// .calecycle.ca. ov/ Facilities irectory ii ata.asx <br /> Facility/Site Name: ��p¢r i a` tlJe.'��cJ r1 P3�vlu G�'S <br /> Facility/Site Location/Address: QQWO S. Oo%j s- <br /> Nearest City/Place Name-T( County: S t4) JOlAC�Uir1 State CA Zip: `tan - <br /> Facility locator info: Decimal Degrees= Longitude: - ❑ ❑ ❑ . 1111 ❑ ❑ ❑ Latitude ❑ ❑ . ❑ ❑ ❑ ❑ ❑ <br /> -or- Degrees, Minutes, and Seconds: Long: - Lat: <br /> Assessor Parcel Number(s): al.-k]6010 <br /> Ma #: Section: Township: Range: Base/Meridian: <br /> Person/Operator Name/Company Name: 7.m pos iu� t5'�Gr,n U)ye�u.L�S <br /> Last Name: P:re-S First Name:—K)�J)C4e, MI: <br /> Title: Mgo Me,f Organization: <br /> Mailing Address: Q.0 <br /> City: CoCC'C)6?_tIra, State: CA Zip: ® ® ® ® ®— 011110 <br /> Phone Number: ( tap ) ® ® 4- 9 ® N ® FAX: ( ) 1111 ❑- ❑ ❑ ❑ ❑ <br /> E-Mail Address: <br /> Person/operator Name/Company Name: <br /> Last Name: First Name: MI: <br /> Title: (( }}�� Organization: <br /> Mailing Address: �l L(44ck Q'GLC C 1 jc kx--. <br /> City: State: i Zip: ® R ® ® 1q— ❑ ❑ ❑ ❑ <br /> Phone Number: (ga„S ) ® ® ®- ® ® ® ® FAX: ( ) ❑ 110- ❑ ❑ ❑ ❑ <br /> Email Address: <br /> LEA or Operator or Owner signature: X Phone: i7� Date: �!q'13 <br /> Supporting documents attache Maps attached All signatures and dates present on documents <br /> See:http://www.calreevele.ca.aov/SWFacilities/Directory/MinimumData.asox <br /> ------------------------------------------------------------------------------------------------- ----------------- <br /> Unit Activity(s) name(s)and Code#: ff1Q + V -C( n Pf0 F Gr�IT <br /> (See back of this form for list of Activity types and codes) <br /> Check one each: 11 <br /> Reeulatory Status Oaerator Type Operational Status Inspection Frequency. M 1Ui <br /> ®,Permitted ❑Federal ❑Planned Closure year(date): <br /> ❑Unpermitted ❑State 5QActive TonsNolume per rDay: `7 S Ons A" <br /> ❑Exempt ❑County ❑Inactive Permit Date: I <br /> ❑EA Notification ❑City ❑Closed EA Notification date: <br /> ❑Excluded M Private ❑ Clean Closed <br /> ❑Proposed ❑District ❑To be Determined l <br /> List one or more Types of Waste to be received/permitted(see back of this form for list of waste types/code#): �B( y r A u 61'G 1 P G7 Ftri e1-S�,l <br /> ***Required CalRecycle staff signature(Received and reviewed for completeness) <br /> by: Phone Date <br />