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State of California Departm ,, Resources Recycling and Recovery CalRecycle 169 (Rev. 12/17) (CalRecycle) ENFORCEMENT AGENCY NOTIFICATION Enforcement Agency: I Cod — Official Use Only SWIS Number: County: SCL.YI j n Date Received: I. GENERAL INFORMATION Operation Name: I Ad Van "_0j So 11S Address: 1430 S. 04mpbed I RJ city: Cajon State: CA zip: 195,520 Phone: 209 4qq 31639 Fax: Operator Name: I We Son ur ad _ Address: 143D (gym city: a 1p State: Cq zip: g532p Phone: I 22Dq 4qq 316 Fax: Land Owner: I M cL4 Ca+Or> Address: ( �{ W'.6 U City: —c`,�Jpn State: Zip: q5 ?O Phone: I 20q 4015 -HIq I Fax: I 2Dq 4g3S Cp II. OPERATION INFORMATION Authorizing Eligibility(State Section of 14 CCR Division 7,Chapter 3, 3.1 or 3.2):See back for more Sedetails Al,�� f) Type(s) of Waste/Material Handled: Li Y2S po_K_ manure Volume of Waste/Material Handled: 3125 e LJO, S Mo Peak Loading: I z Spm cubic Yards or ❑Tons Annual Loading: 3'1500 (Cubic Yards or ❑Tons Days and Hours of Operation: I-7 —5 _ Fri 6_jA IOperation Acreage: "1 .gE, Brief Description of the Operation: 161,allcad 5nd-_, bi e 4- Ck _&o8 loe_ d. eolle m \(an'ou6 da4rffs -f rc>m oCQ 1 t D III. DOCUMENTATION OF LOCAL NOTIFICATION (check one and submit with EA Notification) ❑ Proof of Compliance with the California Environmental Quality Act(CEQA). ❑ Correspondence from the local planning department that compliance with CEQA is not required for the operation to obtain local land use approval. Written notice to the local planning department of the operator's intent to commence operations. IV. OWNER/OPERATOR CERTIFICATION I hereby certify under penalty of perjury that the rmation p vided is true and accurate to the best of my knowledge and belief. Signature of Land Owner: E' ' Date: z % Signature of Operator: y Date: Completion of this form is not required by regulation;however,it will provide the nor ment agency with the information required by 14 CC 18103.1. • A separate Notification is required for each eligible operation. Please cite only one of the following Title 14 regulations when filling in the"authorizing eligibility"box of Notification Form CalRecycle 169: