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State of California Solid Tv aste Information System (S OO) California Integrated Waste CIWMB 37(Rev.01/2008) Facility/Site/Operation Data Entry Form Management Board 0*** New S W IS Number ❑Update information(*❑ ) ❑ Change in address or phone#s ❑ Request to Archive CIWMB USE ONLY=Faclli /Site/Operation SWIS Number - - /LEA - X .o see: llttp:!/wsr-NN,.ciwmb.ca.gov/SWIS/`MinimumData.htm Facility/Site Name: Morada Produce Co. (facility location is at 500 N.Jack Tone Rd., Stockton, CA 95215) Facility/Site Location/Address: 4700 Block S. Jack Tone Rd., West Side, Stockton, CA 95215(site location) Nearest City/Place Name: Stockton County: State_ Zip: - Facility locator info: Decimal Degrees=Longitude: - ❑ ❑ ❑.❑ ❑ ❑ ❑ ❑ Latitude ❑ 11. ❑ ❑ 1111 ❑ -or- Degrees,Minutes, and Seconds: Long: - Lat: Assessor Parcel Number(s):18102036(site location) ja #: Section: Township: Range: Base/Meridian: Person/Operator Name/Company Name: Morada Produce Co. Last Name: Foppiano III First Name: Henry MI: Title: Business Owner Organization: Morada Produce Co. Mailing Address: P.O. Box 659 City:Linden State: CA Zip: n [E ❑2 0 ©- ❑ ❑ ❑ ❑ Phone Number: (209 ) R� A ©- E A © FAX:(209 ) ® ©- A ❑2 Y E-Mail Address: Person/Operator Name/Company Name: Last Name: Castellanos First Name:Robert&Maria MI: Title: Property Owner of Site Location Organization: Mailing Address: 11003 S. Jack Tone Rd. City: Stockton State: CA Zip: [�d ❑5 9 ❑1 ❑5 - ❑ ❑ ❑ ❑ Phone Number: (209 ) A © ❑2 - ® ❑3 ❑2 F21 FAX:( ) ❑ ❑ ❑- ❑ ❑ ❑ ❑ E=Mail Address: LEA°r Operator or Owner signature: X Phone LtM Date: lb 0 IJ Supporting documents attac d ®Maps attached ❑All signatures and dates present on documents See http:r-+w ti ci�mh. a.eo iS«ISr'�tinimwnData.htm ------------------------------------------------------------------------------------------------- ----------------- Unit Activity(s) name(s)and Code#: (See back of this form for list of Activity types and codes) Check one each: Regulatory Status Operator Tyne Operational Status Inspection Frequency: annually ❑Permitted ❑ Federal ❑Planned Closure year(date): ❑Unpermitted ❑ State ® Active TonsNolume per Day: 5 tons/day ®Exempt ❑ County ❑Inactive Permit Date: ❑EA Notification ❑ City ❑Closed EA Notification date: ❑Excluded ®Private ❑Clean Closed ❑Proposed ❑District ❑To be Determined List one or more Types of Waste to be received/permitted(see back of this form for list of waste types/code#) ***Required CIWMB staff Signature(Received and Reviewed for completeness) by: X Phone: Date: