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State of California Solid Waste Information System (SWIS) Department of Resources Recycling <br /> CalRecycle 37 (Rev. 12/17) and Recovery (CalRecycle) <br /> Facility/Site/Operation Data Entry Form <br /> ❑ * * * New SWIS Number Update information ( * ❑ ) El Change in address or phone #sE] Request to Archive <br /> CALRECYCLE USE ONLY=Facility/Site/Operation SWIS Number 39 _ CR _ 34 / LEA 39 - AA <br /> * Facility Locator Information see: Minimum Data Required to Issue New SWIS Number <br /> Facility/Site Name : City of Tracy LF <br /> Facility/Site Location/Address : 30707 S Corral Hollow Road <br /> Nearest City/Place Name : Tracy County : San Joaquin State CA Zip : 95377 _ <br /> Facility locator info : Decimal Degrees = Longitude . - ❑ ❑ ❑ . ❑ ❑ 111111 Latitude ❑ ❑ . 1111 ❑ ❑ ❑ <br /> -or- Degrees, Minutes, and Seconds : Long: - Lat : <br /> Assessor Parcel Number(s) : 25303015 , 25303004, 25303016 <br /> Map# : Section: Township : Range : Base/Meridiam <br /> ❑✓ * Operator (Business Owner) Information <br /> Person/Operator Name/Company Name : CB Tracy Parcel Three Property , LLC <br /> Last Name : Whitaker First Name : Fred MI : M <br /> Title : Agent Organization: Parcel 25303015 <br /> Mailing Address : 3633 Inland Empire Blvd , Suite 500 <br /> City: Ontario State : CA Zip : ❑9 ❑1 ❑7 © ® ' ❑ ❑ ❑ ❑ <br /> Phone Number : ( ) ❑ ❑ ❑ - ❑ ❑ ❑ ❑ FAX : ( ) ❑ ❑ ❑ - 1111 ❑ ❑ <br /> E- Mail Address : <br /> © * Land Owner(s) [Property Owner(s)] Information <br /> Person/Operator Name/Company Name: CB Tracy Parcel Three Property, LLC <br /> Last Name : Whitaker First Name : Fred MI : M <br /> Title: Agent Organization: Parcel 25303015 <br /> Mailing Address : 3633 Inland Empire Blvd , Suite 500 <br /> City : Ontario State : CA Zip : M N 0 © 1 11111111 <br /> Phone Number : ( ) ❑ ❑ ❑ - ❑ ❑ ❑ ❑ FAX : ( ) ❑ ❑ ❑ - ❑ ❑ ❑ ❑ <br /> Email Address : <br /> * * *Required Signature for submitta to a ycle with supporting documents and maps : <br /> LE or Operator or Owner signature : X Phone: (209) 468-2986 Date: 05/15/2023 <br /> ® Supporting documents arta' ed ®Maps attached DAII signatures and dates present on documents <br /> See : http://www.calrecvcle. ca.eov/SWFacilitics/Directory/MinimumData.asng <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> * Facility /Site / Unit: Characteristics /Specifications : <br /> UnitActivity(s) name(s) and Code #: Closed unpermitted solid waste landfill , 08 <br /> (See back of this form for list of Activity types and codes) <br /> Check one each: <br /> Reeulatory Status Operator Type Operational 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 />