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State of California <br /> CIWMB 169(Rev 4/04'; <br /> California Integrated Waste <br /> ENFORCEMENT AGENCY NOTIFICATION management Board <br /> V. <br /> S <br /> ! <br /> EE n—t A—ge n—c, ! <br /> ------...— AN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPT. Official e only-_ --­——� i <br /> County: SAN JOAQUIN COUNTY OVVI%-) NUM <br /> Date Received. <br /> .__ <br /> I. GENERAL WFORMATIDN. <br /> I Operation Name: <br /> ----------- ' WESTERN� <br /> ORGANICS, INC - GRO-WELL BRANDS CP INC <br /> Zip: <br /> j <br /> V 1� <br /> City:Y 7�! Us VT�OLC K T 0 N <br /> Address: 4343 MCK'INLEY AVE. <br /> — C�K <br /> Phone; <br /> 0: C <br /> h 09 9 itY: 1 STOCK <br /> hone: CA <br /> 2 9�2- _ State,_ <br /> 209-982-4936 - �95206 <br /> 209-982-4937 <br /> Operator Na I-Ij -- <br /> WESTERN I WESTERN ORGANICS, INC-GRO-WELL BRANDS CP INC. <br /> Address: 4343 MCKINLEY AVE. C. <br /> ItT �STOC <br /> IN: i STOC�KTON��State� <br /> Phone: State: Zip: 95iO6 <br /> �Zipd 95; <br /> I Fax: 209- 2-4937 <br /> Land Owner. <br /> MCKINLEY WAY PROPERTIES, INC <br /> Address: 1 P.O. BOX 434 <br /> __��te- TCA 'I�Zi pry �14 <br /> City: ; RIPON <br /> Phone: 1 209-982-4936 —1 I State: 5366 <br /> F 9 <br /> ax: 1 209-982-4937 <br /> 11, OPERATION INFORMATION <br /> i Authori7ing Eligibility(State Section of 14 CCR Division 7,Chapter 3 or 3.1):S LIMITED VOLUME <br /> See back iSECTION, 17403.3TRAN��F--t-R—­', <br /> T <br /> lYPe(S)OfWaste/Matedal Handled: ' SHEETROCK <br /> Volume of Waste/Material Handled: APPROX 10 TONSP`ERDAY <br /> Peak Loading- 15 TONS 0,-u Ic <br /> b; Ya-d's Or Z Tons Annual Loading: <br /> - 2500 COii;Yardsor E'rom <br /> I <br /> Days and Hours of Operation: 1 7:00 AM -4-00 PM M-F <br /> Operabon AC 24 ACRES <br /> Brief Description OT the Operation: <br /> RECEIVING BULK SHEETROCK <br /> RELOADING & HAULING TO PROCESSON IN- <br /> ST�ANISLAUS CO <br /> III. DOCUMENTATION OF LOCAL NOTIFICATION (check one and submit with EA Notif❑ ication) <br /> I Proof Of Compliance with the California Environmental Quality Act(CEQA). <br /> i Correspondence from the local lannillydepartment that compliance with CE <br /> QA <br /> I land use a�al. QA is not required for the operation to <br /> ❑ Written notice to the local planning department the operator's interitt0 commence operations.. <br /> IV. ow"r-nJV <br /> urtKATOR CERTIFICATION <br /> ------------- <br /> --------------- <br /> 1 here-by cern fy under-enajt,,of perjury that the informatbnprovided is true and accurate to the best Of my knowledge and belief, <br /> Signature of Land <br /> i Date: <br /> Signature of <br /> Operator: <br /> Date: <br /> ComPletion of this form.is noiTequired by however.ij will prov <br /> 0 A separate No-.i11ic_a,:o!7.is requiredor each eligible o.perat;0.1. ide!he enforcement agency with the information required by 14 CCR 18103.1 <br />