Laserfiche WebLink
1 <br /> ✓ - <br /> Stat of California Solid Aste Information System (S % California Integrated Waste <br /> CIWMB 37(Rev.01/2008) Facility/Site/Operation Data Entry Form Management Board <br /> El*** New S WIS Number ❑Update information(*❑ ) 11 Change in address or phone#s ❑ Request to Archive <br /> CIWMB USE ONLY= lity <br /> Fa SWIS Number - - /LEA <br /> see: - <br /> littp://,vvww.ciwmb.ca.gov/SWIS[Minimuml)ata.htm <br /> //Www.ciw b.ca.g ov/SW IS[Minimuml)ata.ht <br /> l a <br /> Facility/Site Name: Prima Frutta Packing, Inc <br /> Facility/Site Location/Address: 16461 E. Comstock Rd., Linden CA 95236 <br /> Nearest City/Place Name: Stockton County: State_ Zip: - <br /> Facility locator info: Decimal Degrees=Longitude: - 111111.❑ ❑ ❑ ❑ ❑ Latitude ❑ 11 .❑ ❑ ❑ ❑ ❑ <br /> -or- Degrees,Minutes,and Seconds: Long: - Lat: <br /> Assessor Parcel Number(s):06520003 <br /> Mai# Section Township: Range: Base/Meridian: <br /> Person/Operator Name/Company Name: Prima Frutta Packing, Inc <br /> Last Name: Sambado First Name: Tim MI: <br /> Title: owner Organization: Prima Frutta Packing, Inc <br /> Mailing Address: 16461 E. Comstock Rd <br /> City:Linden State: CA Zip: F91 ® 0 0 ©- ❑ ❑ ❑ ❑ <br /> Phone Number: (209FAX:(209 ) - ® © <br /> E-Mail Mail Address: tims@pf-pv.com <br /> L! tio <br /> Person/Operator Name/Company Name: Prima Frutta Packing, Inc <br /> Last Name: Sambado First Name:Tim MI: <br /> Title: owner Organization: Prima Frutta Packing, Inc <br /> Mailing Address: 16461 E. Comstock Rd. <br /> City:Linden State: CA Zip: ❑9 ❑5 ❑2 [N ©- ❑ ❑ 1111 <br /> Phone Number: (209 ) A9 ❑3 1❑- 1❑ ® © ❑0 FAX:(209 ) ❑9 ❑31❑- ❑1 <br /> E-Mail Address: tims anpf-pv.com <br /> LEA or Operator or Owner signature:X Phone: Date: <br /> ❑ Supporting documents attached ®Maps attached ❑All signatures and dates present on documents <br /> See 6ttpa%��wu.ci��mb.ea. a�lS4b'IS%biinimwt�t:kua.htin <br /> ------------------------------------------------------------------------------------------------- ----------------- <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 /> Rezulatory Status Operator Type Operational Status Inspection Frequency: annually <br /> ❑Permitted ❑ Federal ❑Planned Closure year(date): <br /> ❑Unpermitted ❑ State ® Active TonsNolume per Day: 10 tons/day <br /> ®Exempt ❑ County ❑Inactive Permit Date: <br /> ❑EA Notification ❑ City ❑Closed EA Notification date: <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 />