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btate of t-amorma Solid Waste lniormationstem W 15 <br /> Department ofHesources Recycling <br /> CalRecycle 37(Rev.12/17) � � and Recovery(CalRecycle) <br /> Facility/Site/OQeration Data Entry Form <br /> *** New SWIS Number Update information(*❑ )EIChange in address or phone#sORequest to Archive <br /> CALRECYCLE USE ONLY=Facility/Site/Operation SWIS Number 39 _CR -33 /LEA - <br /> ❑* Facility Locator Information see: Minimum Data Required to Issue New SWIS Number <br /> Facility/Site Name:World Enterprises <br /> Facility/Site Location/Address:E.Side of Turnpike Rd.,700 ft of Dow <br /> Nearest City/Place Name:Stockton County:San Joaquin State CA Zip:95201 _ <br /> Facility locator info: Decimal Degrees= Longitude: - ❑ ❑ ❑ . ❑ 11111111 Latitude ❑ ❑ . ❑ ❑ ❑ ❑ ❑ <br /> -or- Degrees,Minutes,and Seconds: Long: - Lat: <br /> Assessor Parcel Number(s):175190010 <br /> Map#: Section: Township: Range: Base/Meridian: <br /> ❑* Operator(Business Owner) Information <br /> Person/Operator Name/Company Name: <br /> Last Name: First Name: MI: <br /> Title: Organization: <br /> Mailing Address: <br /> City: State: Zip: ❑ ❑ ❑ 110— 1111 ❑ ❑ <br /> Phone Number: ( 1111 ❑- 1111011 FAX: ( ) E11] [1- ❑ ❑ ❑ ❑ <br /> E-Mail Address: <br /> ®* Land Owner(s) [Property Owner(s)]Information <br /> Person/Operator Name/Company Name: <br /> Last Name:Singh First Name:Jamsher MI: <br /> Title: Organization: <br /> Mailing Address:17715 Golden Spike Trail <br /> City:Lathrop State:CA Zip: 9❑ ❑5 ❑3 ❑3 0❑_ ❑ ❑ ❑ ❑ <br /> Phone Number: (209 ) 0 - ® ❑5 ❑7 FAX: ( ) ❑ ❑ ❑- ❑ ❑ ❑ ❑ <br /> Email Address: <br /> ***Required Signature for submittal to CalRecycle with supporting documents and maps: <br /> LEA or Operator or Owner signature: Xmf Phone:(209)468-0338 Date:05/28/2024 <br /> ❑Supporting documents attached ❑Maps attached ❑All signatures and dates present on documents <br /> See :http://www.calrecycle.ca.¢ov/SWFacilities/Directory/MinimumData.asl)x <br /> ------------------------------------------------------------------------------------------------- ----------------- <br /> ❑* Facility/Site/Unit: Characteristics /Specifications: <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 /> Reeulatory Status Onerator Tvoe ouerational Status Inspection Frequency:quarterly <br /> ❑Permitted ❑Federal ❑Planned Closure year(date): <br /> ✓❑Unpermitted ❑State ❑Active TonsNolume per 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 CalRecycle staff signature (Received and reviewed for completeness) <br /> by: Phone Date <br />