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State of California <br />Solid Ste Information System (S _ `) California Integrated Waste <br />CIWMB 37 (Rev. 01/2008) Facility / Site /Operation Data Entry Form Management Board <br />❑✓ *** New SWIS Number ❑ Update information(* ❑ ) ❑ Change in address or phone #s ❑ Request to Archive <br />CIWMB USE ONLY Facility/Site/Operation SWIS Number - - / LEA - <br />Lokcafor Tn%rmt>on see: http://www.ciwmb.ca.gov/SWIS/MinimumData.htm <br />Facility/Site Name: Valley Organics, Inc <br />Facility/Site Location/Address: 920 W. Frewert Road <br />Nearest City/Place Name: Lathrop County: San Joaquin State CA <br />Facility locator info: Decimal Degrees = Longitude: - 1� 121 Ifl . 3❑ ❑0 M ❑7 1❑ Latitude 171. ®® o a <br />-or- Degrees, Minutes, and Seconds: Long: - -121.3077135858 Lat: 37.8474136503 <br />Assessor Parcel Number(s): 191-260-22 <br />Map#: Section: Township: Range: Base/Meridian: <br />77 <br />�* V for (Busyness .Owner) > nformatlop <br />Person/Operator Name/Company Name: Valley Organics, Inc <br />Last Name: Oliver <br />Title: President <br />Mailing Address:_ <br />City: Lodi <br />Zip: 1�1[N®®[�- <br />Phone Number: ( 209) ❑3 ❑3 ®- 51 © 1E ❑9 FAX: ( 209) ❑3 0 ® - #F01 ® ❑7 <br />E- Mail Address: <br />�* Land Otivner(s) [Property Owners,] 1nf4rmahon: <br />Person/Operator Name/Company Name: James E and Patricia L Sanchez <br />Last Name: Sanchez First Name: James MI: E <br />Land Owner <br />Organization: <br />Mailing Address: 8700 Woodward Lake Drive <br />City: Oakdale State: CA Zip: IR 0 g © E - ❑ ❑ ❑ ❑ <br />Phone Number: ( 209) ®®0 - ®© FAX: ( 209) ®®®_ a o ® o <br />E- Mail Address: <br />--- - --- - ---.�r.:- rg.. ,8 .a ��t,t,.,..�.,� <br />A �.� Phone: 209 468-0332 Date: 2/06/ <br />LEA or Operator or Owner signature: X j (� 09 <br />® Supporting documents attached ® Maps attached ®All signatures and dates present on documents <br />See: http:/hvww.ciwmb.ca.gov/SWIS/MinimuinData.htm <br />Unit Activity(s) name(s) and Code #: 19 Com66itlnQ 06e6166 (Green Waste) <br />(See back of this form for list of Activity types and codes) <br />Check one each: <br />Regulatory Status <br />Operator Tyne <br />Operational Status <br />Inspection Frequency: Quarterly <br />❑ Permitted <br />❑ Federal <br />® Planned <br />Closure year (date): 2011 <br />❑Unpermitted <br />❑ State <br />® Active <br />Tons/Volume per Day: 40 cubic yards/dav <br />❑Exempt <br />❑ County <br />❑ Inactive <br />Permit Date: <br />® EA Notification <br />❑ City <br />❑ Closed <br />EA Notification date: 2/07/09 <br />❑Excluded <br />® Private <br />❑ Clean Closed <br />-]Proposed <br />❑ District <br />❑ To be Determined <br />moist one or more Types of Waste to be received /permitted (see back of this form for list of waste types/ code #) : 13, 10, <br />***Required CIWMB staff Signature (Received and Reviewed for completeness) <br />by: X Phone: Date: <br />