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State of California Solid &ste Information System (S)S) California Integrated Waste CIWMB 37 (Rev. 01/2008) Facility / Site /Operation Data Entry Form Management Board 21*** New SWIS Number ❑Update information(*❑ ) ❑ Change in address or phone #s ❑ Request to Archive CIWMB USE ONLY = Facility/Site/Operation SWIS Number - - / LEA - x Facility Locator Information: see: http://www.ciwmb.ca.gov/SWIS/MinimumData.htm Facility/Site Name: Valley Organics, Inc Facility/Site Location/Address: 920 W. Frewert Road Nearest City/Place Name: Lathrop County: San Joaquin State CA Zip: 95330 - Facility locator info: Decimal Degrees = Longitude: - M 2 ❑1 . ❑3 ❑0 ❑7 ❑71❑ Latitude % M . ®® T 3❑ -or- Degrees, Minutes, and Seconds: Long: - -121.3077135858 Lat: 37.8474136503 Assessor Parcel Number(s): 191-260-22 Map#: Section: Township: Range: Base/Meridian: Q* Operator (Business Owner) information: Person/Operator Name/Company Name: Valley Organics, Inc Last Name: Oliver First Name: Donald mi: W Title: President Organization: Mailing Address: 12900 N. Lower Sacramento Road City: Lodi State: CA Phone Number: ( 209 ) 5 ❑3 ® - 3❑ © INA FAX: ( 209 ) ❑3 ❑3 ® -A 9 ® ❑7 E- Mail Address: w Land Owiner(s) Property Owners}] ilformaho»i Person/Operator Name/Company Name: James E and Patricia L Sanchez Last Name: Sanchez First Name: James MI: E Title: Land Owner Organization: Mailing Address: 8700 Woodward Lake Drive City: Oakdale State: CA Zip: ❑9 ❑5 9 © N- 1111 ❑ ❑ Phone Number: ( 209 ) ®®❑5 - ❑9 0 ®© FAX: ( 209 > ®®❑5 - 0 ❑7 a a E- Mail Address: LEA or Operator or Owner signature: X�.. �..� ® Supporting documents attached See: http://www.ciwmb,ca.gov/SWIS/MinimumData.htm ----------------------------------------- ® Maps attached Unit Activity(s) name(s) and Code #: 19 Compostlna Operation (See back of this form for list of Activity types and codes) Check one each: Regulatory Status Operator Type Operational Status ❑ Permitted ❑ Federal ❑ Planned ❑ Unpermitted ❑ State ® Active ❑Exempt ❑ County ❑ Inactive ® EA Notification ❑ City ❑ Closed Phone: 209 468-0332 Date: 2/06/09 ®All signatures and dates present on documents Inspection Frequency: Quarterly Closure year (date): 2011 Tons/Volume per Day: 40 cubic vards/dav Permit Date: EA Notification date: 2/07/09 ❑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 #) : 13, 10, ***Required CIWMB staff Signature (Received and Reviewed for completeness) by: X Phone: Date: