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State of California Solid' ste Information System (SNW)- <br />California Integrated Waste <br />CIWMB 37 (Rev. 01/2008) Facility / Site /Operation Data Entry Form Management Board <br />Rl*** 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 />2 , <br />* ac>di Loci%r In,,, aeon 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: - Ifl 2 1❑ . ® 10 ❑7 M71❑ Latitude ® N . ®® a a <br />-or- Degrees, Minutes, and Seconds: Long: - -121.3077135858 Lat: 37.8474136503 <br />Assessor Parcel Number(s): 191-260-22 <br />Map#: Section: Townchin Randa• u,�oiAro:a: �. <br />Person/Operator Name/Company Name: <br />Last Name: Oliver First Name: Donald <br />Title: President <br />Mailing Address: <br />City: <br />v©oda <br />Phone Number: ( 209) 0 ®- o ©a a FAX: ( 209) 0 O ®- 0 A ® r7] ^ <br />E- Mail Address: <br />R* Land Owner(s) [P'r®party Ownr(snfctxatign <br />Person/Operator Name/Company Name: James E and Patricia L Sanchez <br />Last Name: Sanchez First Name: James MI: E <br />Title: Land Owner <br />Organization: <br />Mailing Address: 8700 Woodward Lake Drive <br />City: Oakdale State: CA Zip: IMCON- - ❑❑00 <br />Phone Number: ( 209) ®®�5 - a a ®© FAX: ( 209) ® R 0 - ❑9 F71 ❑3 1 <br />E- Mail Address: <br />,.,.. ,a _.. .,.r.v ... _". ;:: .-. •-- �. ... r:C .-,.,. .•<:f'l.an Y;aaa+av!!}1.a7 K:�7,i t1}i[i�iJ i': <br />LEA or Operator or Owner signature: X ' �Q �� Phone. 209 468-0332 Date. 2/06/09 <br />® Supporting documents attached ® Maps attached ®All signatures and dates present on documents <br />See: http:/h\,xm.ciwmb.ca.gov/SWIS/MinimumData.btm <br />Unit Activity(s) name(s) and Code #: 19 CoMpostihq ODeratlon (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 vards/div <br />❑Exempt <br />❑ County <br />❑ Inactive <br />Permit Date: <br />® EA Notification <br />❑ City <br />❑ Closed <br />EA Notification date: 2/07/09 <br />OExcluded <br />® Private <br />❑ Clean Closed <br />3 Proposed <br />❑ District <br />O To be Determined <br />List 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 />