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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(*❑ )E]Change in address or phone 4:1 Request to Archive <br /> CALRECYCLE USE ONLY=Facility/Site/Operation SWIS Number 39 _CR -25 /LEA - <br /> ❑✓ * Facility Locator Information see: Minimum Data Required to Issue New SWIS Number <br /> Facility/Site Name:Manteca County Dump <br /> Facility/Site Location/Address:21800 S Manteca Rd. <br /> Nearest City/Place Name:Manteca County:San Joaquin State CA Zip:95337 _ <br /> Facility locator info: Decimal Degrees=Longitude: - ❑ ❑ ❑ . ❑ ❑ ❑ 110 Latitude ❑ ❑ . ❑ ❑ ❑ ❑ ❑ <br /> -or- Degrees,Minutes,and Seconds: Long:- Lat: <br /> Assessor Parcel Number(s):22612012 <br /> Map#: Section: Township: Range: Base/Meridian: <br /> R1* Operator(Business Owner)Information <br /> Person/Operator Name/Company Name:In Care of wade Law Offices <br /> Last Name: First Name: MI: <br /> Title: Organization:Wade Law Offices <br /> Mailing Address: 1677 Eureka Rd.ST.#203 <br /> City:Roseville State:CA Zip: ❑9 ❑5 © © 1❑— ❑ ❑ ❑ ❑ <br /> Phone Number: (800 ) ® 3� - 2❑ © ❑3 ® FAX:( ) 0110- 0 ❑ ❑ ❑ <br /> E-Mail Address: <br /> 0* Land Owner(s) [Property Owner(s)]Information <br /> Person/Operator Name/Company Name:In Care of Wade Law Offices <br /> Last Name: First Name: MI: <br /> Title: Organization:Wade Law Offices <br /> Mailing Address:1677 Eureka Rd.ST.#203 <br /> City:Roseville State:CA Zip: ❑ ❑ ❑ ❑ <br /> Phone Number: (800 ) ® ❑3 N— 2❑ © ❑3 ® FAX:( ) ❑ ❑ ❑— ❑ ❑ ❑ ❑ <br /> Email Address: <br /> ***Required Signature for submittal to CalRecycle with supporting documents and maps: <br /> 4 D to 2102<U,01Y163921-0r° ' Phone:(209)468-3526 Date:04/01/2024 <br /> LEA or Operator or Owner signature: X ">L' <br /> ❑Supporting documents attached ❑Maps attached ®All signatures and dates present on documents <br /> See :http://www.calrecycle.ca.eov/SWFacilities/Directory/MinimumData.asvx <br /> ------------------------------------------------------------------------------------------------- ----------------- <br /> V]* 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 Operator Tyne 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 />