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s . State of California Solid Aste Information System (SVA) California Integrated Waste CIWMB 37(Rev.01/2008) Facility/Site/Operation Data Entry Form Management Board ❑✓ *** New SWIS Number ❑Update information(*❑ ) 11 Change in address or phone#s ❑ Request to Archive CIWMB USE ONLY=Facility/Site/Operation SWIS Number - - /LEA 01 -4MIM see: littp://-,v-*N-i-*,,.ciwmb.ca.gov/SW.I.S/`Minimuinl)ata.htm Facility/Site Name: Prima Frutta Packing, Inc Facility/Site Location/Address: 16461 E. Comstock Rd., Linden CA 95236 Nearest City/Place Name: Stockton County: State_ Zip: - Facility locator info: Decimal Degrees=Longitude: - 11110. 00 ❑ ❑ ❑ Latitude ❑ ❑ . ❑ ❑ ❑ ❑ ❑ -or- Degrees, Minutes,and Seconds: Long: - Lat: Assessor Parcel Number(s):06520003 Of", # p: Range: Base/Meridian: y��4n�fi:x .G6�A� W"nG�:�'AW�i'i �IIN n;Y' n i Person/Operator Name/Company Name: Prima Frutta Packing, Inc Last Name: Sambado First Name: Tim MI: Title: owner Organization: Prima Frutta Packing, Inc Mailing Address: 16461 E. Comstock Rd City:Linden State: CA Zip: ❑5 ©- ❑ ❑ ❑ ❑ Phone Number: (209 ) 11 1❑- 1❑ ® © ❑0 FAX:(209 ) ❑9 a [E- 1❑ E-Mail Address: tims@pf-pv.com Person/Operator Name/CompanyName:�Prima Frutta Packing. Inc Last Name: Sambado First Name:Tim MI: Title: owner Organization: Prima Frutta Packing, Inc Mailing Address: 16461 E. Comstock Rd. City:Linden State: CA Zip: ❑9 n ❑2 IN ©- ❑ ❑ ❑ ❑ Phone Number: (209 ) ❑9 ❑3 ❑1 - a a a a FAX:(209 ) ❑9 - ❑1 ® © E-Mail Address: tims anpf-Pv.com LEA or Operator or Owner signature: X �' �' �J �— Phone:1�q V 0033 Date 3 ❑ Supporting documents attached ®Maps attached El All signatures and dates present on documents See:http:;h�w��.ci�amb.�a.g<ndS��'IS'hlinimuu�U:ita.ht�ri -------------------------------------------------------------------------------------------------- ----------------- Unit Activity(s) name(s)and Code#: (See back of this form for list of Activity types and codes) Check one each: Reaulatory Status Operator Type Operational Status Inspection Frequency: annually ❑Permitted ❑ Federal ❑Planned Closure year(date): ❑Unpermitted ❑ State ® Active TonsNolume per Day: 10 tons/dav ®Exempt ❑ County ❑Inactive Permit Date: ❑EA Notification ❑City ❑Closed EA Notification date: ❑Excluded ®Private ❑Clean Closed ❑Proposed ❑District ❑To be Determined List one or more Types of Waste to be received/permitted(see back of this form for list of waste types/code#) ***Required CIWMB staff Signature (Received and Reviewed for completeness) by: X Phone: Date: