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40 IRECEi'Eool <br /> State of California JUN 1 0 2009 <br /> CIWMB 169(Rev 4/04) California Integrated Waste <br /> N - ' LTH Management Board <br /> ENFORCEMENT <br /> LW <br /> AGENCYE 141, - S <br /> i[.Enfbrrement Agency: [SAN JOAQUIN CO`Uj Official Use Only <br /> ENVIRONMENTAL HEALTH 15f SWIS Number <br /> County: SAN JOAQUIN COUNTY <br /> Date Received: <br /> F_ <br /> I. GENERAL INFORMATION <br /> Operation Name: WESTERN ORGANICS, INC - G RO-WELL BRANDS CPINC <br /> Address: 4343 MCKINLE�AVIE. <br /> P 0 Address: <br /> 09_98 City: 1 STOCKTON State: I CA T,,iZjp-:' TE-95206 <br /> Phone: 209-982-4936 <br /> Fax: 1 209-982-4937 <br /> Operator Name: <br /> WESTERN ORGANICS, INC-GRO-WELL BRANDS CP INC. <br /> Address: <br /> _ <br /> 4343 CI LEY AVE. City: j STOCKTON <br /> TState: CA Zip: 95206 <br /> Phone: 209-982-4936 _J Fax. 209-982-4937 <br /> Land Owner IMCKINLEY WAY PROPERTIES, INC <br /> Address: P.O. BOX 434 City: !RIPON State: 95366 <br /> :P�ho�ne- j 209-982-4936 Fax: 209-982-4937 <br /> 11. OPERATION INFORMATION <br /> LIMITED VOLUM <br /> I Authorizing Eligibility(State Section of 14 CCR Division 7,Chapter 3 or 3.1):See back for more details SECTION, 17403.3 TRANSFER— f <br /> Type(s)of Waste/Material Handled: SHEETROCK <br /> ! Volume of Waste/Material Handled: APPROX 10 TONS PER DAY <br /> Peak Loading: 15 TONS 0 Cubic Yards or N Tons 1 Annual Loading: 2500 El Cubic Yards or Tons <br /> Days and Hours of Operation: 1' 7:00 AM -4:00 - f Operation Acreag—e- <br /> ACRES <br /> Brief Description of the Operation: <br /> RECEIVING BULK SHEETROCK <br /> RELOADING & HAULING TOP IN TIS US CO <br /> Ill. DOCUMENTATION OF LOCAL NOTIFICATION (check one and submit with EA Notification) <br /> Proof of Compliance with the California Environmental Quality Act(CEQA). <br /> Correspondence from the local planning department that compliance with CE QA is <br /> not required for the operation to <br /> obtain local land use approval. <br /> ❑ Written notice to the local planning department of the operatoes intent to commence operations. <br /> IV. OOR CERTIFICATION <br /> I hereby certify under penalty of perjury that the information provided is true and accurate to the best of my knowledge and belief. <br /> Signature of Land Owner: <br /> a e of and Owner: Date: <br /> Date:�_ <br /> —�e)7 <br /> E?W,t will o'. <br /> M <br /> ign tur L <br /> Signature <br /> of to <br /> ignature of Operator: Date: <br /> is I not <br /> m <br /> Completion of this form is not required by reg ationw;however,it will provide the enforcement agency with the information required by 14 CCR 18103.1. <br /> ® A separate NoTification is required for each eligible operation. <br />