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r State of California California Integrated Waste CIWMB 169(Rev 4104) Management Board ENFORCEMENT AGENCY NOTIFICATION Enforcement Agency: I Si County Environmental Health Official Use Only SWIS Number: County: I San Joaquin Date Received: I. GENERAL INFORMATION Operation Name: I Imperial Western Products Address; 20500 S.Holly Drive City: Tracy State: CA Zip: 95304 Phone: 1 (559)707-3551 Fax: Operator Name: IImperial Western Products Address: I P.O.Box 1110 City: Coachella State: CA Zip: 92236 Phone: 1 (760)378-0815 1 Fax: Land Owner: I Holly Commerce Center,LLC Address: 21 Lafayette Circle City: Lafayette State: CA Zip: 94549 Phone: 1 (925)283-8777 Fax: It. OPERATION INFORMATION Authorizing Eligibility{State Section of 14 CCR Division 7,Chapter 3 or 3.1}: CCR 14 Section 17403.3—Limited Volume Transfer See back for more details Operation Type(s)of Waste/Material Handled: Packaging—paper,cardboard,and plastic Volume of Waste/Material Handled: 3 to 7 tons per day Peak Loading: 7 ❑Cubic Yards or®Tons Annual Loading: 1,200 ❑Cubic Yards or®Tons Days and Hours of Operation: I 5am to 5pm(typically) I Operation Acreage: Brief Description of the Operation: Truckloads of out-of-specification bakery products are received into a warehouse and stored for one to three days prior to being loaded for highway shipping to final destination.We typically receive one to two truckloads per day.Each truckload typically contains 3 to 3.5 tons of trash materials(i.e.paper,plastic,and cardboard from packaging). III. DOCUMENTATION OF LOCAL NOTIFICATION(check one and submit with EA Notification) ❑ Proof of Compliance with the California Environmental Quality Act(CEQA). ❑ Correspondence from the local planning department that compliance with CEQA is not required for the operation to obtain local land use approval. ® Written notice to the local planning department of the operator's intent to commence operations. IV. OWNERIOPERATOR CERTIFICATION I hereby certify under penalty of ury that the information pr ided is true and accurate to the best of my knowledge and belief. Signature of Land Owner: Date: -2,12-- Signature of Operator: j Date: -j(; j-? 'Completion of this form is not required by regulation;however,it will provide the enforcement agency with the information required by 14 CCR 18103.1. • A separate Notification is required for each eligible operation. l