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State of California Solid 'r ste Information System (S I ) California Department of Resources <br /> CalRecycle 37(Rev.2/2014) Fa /Site/® eration Data Enta Form Recycling and Recovery El*** New SWIS Number X Update information(* ) Change in address or phone#s Request to Archiv, <br /> CALRECYCLE USE ONLY=Facility/Site/Operation SWIS Number 39 -CR -0022 /LEA 39 -AA <br /> `� see: http://wwW.calrecycle.ca.gov/S acilities irectory inimum ata.aspx <br /> Facility/Site Name:P1lkmgton North America, Inc. <br /> Facility/Site Location/Address:500 E. Louise Avenue <br /> Nearest City/Place Name:Lathrop County: San Joaquin State CA Zi-0:95330- <br /> Facility <br /> ip:95330-Facility locator info: Decimal Degrees=Longitude: - Latitude <br /> -or- Degrees,Minutes, and Seconds: Long: - Lat: <br /> Assessor Parcel Number(s): <br /> Ma p#: Section Township: Range: Base/Meridian: <br /> Person/Operator Name/Company Name: <br /> Last Name: First Name: MI: <br /> Title: Organization: <br /> Mailing Address: <br /> City: State: Zip: — <br /> Phone Number: ( ) - FAX: ( ) <br /> E-Mail Address: <br /> Person/Operator Name/Company Name: ASP/RWM Properties � t <br /> Last Name: First Name: MI: <br /> Title: Organization: <br /> Mailing Address:2228 Livingston Street <br /> City: Oakland State:CA Zip:94606 - <br /> Phone Number: ( ) - FAX: ( ) <br /> Email Address <br /> . d ars e�c ^yfl <br /> q <br /> fl1 `S a t(hh� t1GY'Wltl t ( 1C1I1 <br /> A.v d, ggYt,�. <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:http//www salrecycle ca$ov/SWFacilities/Directorv/MinimumData.aspx <br /> ------------------------------------------------------------------------------------------------- ----------------- <br /> aj#� . <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 /> Regulatory Status Operator Type Operational Status Inspection Frequency:Quarterly <br /> Permitted ❑Federal ❑Planned Closure year(date): <br /> x❑Unpermitted []State OActive TonsNolume per Day: <br /> ❑Exempt ❑County DInactive Permit Date: <br /> ❑EA Notification ❑City NClosed EA Notification date: <br /> ❑Excluded ❑ Private ❑ Clean Closed <br /> ❑Proposed DDistrict 0To 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 />