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STATE WATER RESOURCES CONTROL BOARD <br />ORDER WQ 2020-0004-DWQ <br />GENERAL WASTE DISCHARGE REQUIREMENTS for DISASTER-RELATED WASTES <br />26 <br />ATTACHMENT C NOTICE OF INTENT <br />State Water Resources Control Board <br />Order No. 2020-0004-DWQ <br />TO COMPLY WITH GENERAL WASTE DISCHARGE REQUIREMENTS FOR <br />DISASTER-RELATED WASTES <br />I. PROPERTY / FACILITY <br />INFORMATION <br />Property/Facility Name: <br />___________________________________ <br />Property/Facility Contact: <br />___________________________________ <br />Property/Facility Address: <br />___________________________________ <br />City: ______________________________ <br />County: ____________________________ <br />State: _____________________________ <br />Zip: _______________________________ <br />Telephone: _________________________ <br />Fax: _______________________________ <br />Email: _____________________________ <br />Assessor Parcel Number(s): <br />___________________________________ <br />II. PROPERTY / FACILITY OWNER <br />INFORMATION <br />Property/Facility Owner Name: <br />___________________________________ <br />Owner Mailing Address: <br />___________________________________ <br />City: ______________________________ <br />County: ____________________________ <br />State: _____________________________ <br />Zip: _______________________________ <br />Telephone: _________________________ <br />Fax: _______________________________ <br />Email: _____________________________ <br />III. PROPERTY / FACILITY OPERATOR <br />INFORMATION <br />Property/Facility Operator Name: <br />___________________________________ <br />Operator Mailing Address: <br />___________________________________ <br />City: ______________________________ <br />County: ____________________________ <br />State: _____________________________ <br />Zip: _______________________________ <br />Telephone: _________________________ <br />Fax: _______________________________ <br />Email: _____________________________ <br />Assessor Parcel Number(s): <br />___________________________________ <br />Forward, Inc. Landfill <br />Osvaldo Cordero <br />9999 S. Austin Road <br />Manteca <br />San Joaquin <br />California <br />95336 <br />209-601-2274 <br />N/A <br />ocordero@republicservices.com <br />181-050-07, 181-050-08, 181-150-09, 181-150-10, 201-060-02 <br />201-060-03, 201-060-04, 201-070-01 <br />Forward, Inc., a Subsidiary or Republic Services <br />1145 West Charter Way <br />Stockton <br />San Joaquin <br />California <br />95206 <br />209-466.3604 <br />BBorba@republicservices.com <br />Forward, Inc., a Subsidiary of Republic Services <br />1145 West Charter Way <br />Stockton <br />San Joaquin <br />California <br />95206 <br />209-466-3604 <br />N/A <br />N/A <br />BBorba@republicservices.com <br />181-050-07, 181-050-08, 181-150-09, 181-150-10, 201-060-02 <br />201-060-03, 201-060-04, 201-070-01