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State of California California Integrated Waste <br /> CIWMB 500(Rev. 10/02) Management Board <br /> WASTE TIRE FACILITY <br /> PERMIT APPLICATION <br /> I. TYPE OF APPLICATION (please print or type) SWIS#: <br /> ® New ❑ Permit ❑ Permit CIWMB use onl <br /> Permit Renewal Revision Date Received: <br /> ❑ Application Date Accepted.• <br /> Amendment Date Rejected: <br /> II. TYPE OF FACILITY <br /> ® Existing ❑ Proposed <br /> ❑ Major Waste Tire Facility(5,000 or more tires) <br /> ® Minor Waste Tire Facility(500 or more tires,but less than 5,000) <br /> III. GENERAL INFORMATION <br /> Facility Name: PGM Recycling, Inc. <br /> Facility Mailing Address: 19414 North Hwy 99 <br /> City: FAcampo County: San Joaquin State: CA Zip: 95220 1 Phone: 1 209-339-8282 <br /> Facility Location(if different from mailing address): <br /> City: County: State: Zip: I Phone: <br /> Assessor's Parcel Number(s): 017-090-01 GPS Coordinates: Site Acreage: 2.5 Acres <br /> Facility Operator's Name: PGM Recycling,Inc.—James A. Capis <br /> Mailing Address: 19414 North Hwy 99 <br /> City: Acampo County: San Joaquin State: CA Zip: 95220 Phone: 209-333-8282 <br /> Property Owner's Name(if different from operator): <br /> Mailing Address: <br /> City: County: State: Zip: Phone: <br /> IV. AGENCY INFORMATION <br /> Fire Authority Agency Name: Woodbridge Fire Department <br /> Contact Person: Steve Butler Phone: 209-369-1945 <br /> Vector Control/Mosquito Abatement Agency Name: County of San Joaquin Mosquito and Vector Control <br /> Contact Person: Ed Greenmyer Phone: 209-982-4675 <br /> V. TYPE AND QUANTITY OF WASTE TIRES <br /> ❑ Whole Passenger ❑ Whole Truck ❑ Whole Tractor ❑ Split Tires <br /> Type of Waste <br /> Tires Received: F-1Whole Earthmover/Construction Equipment ❑ Cut Tires ElShredded Tires <br /> ® Other: Trailer tires for mobile homes <br /> Number of Waste Tires Stored or Maintained On-Site: 4999 <br /> Maximum Capacity: 4999 <br />