Laserfiche WebLink
State of California Solid Waste Information System (SWIS) Department of Resources Recycling <br /> CalRecycle 37 (Rev. 12/17) \ and Recovery (CalRecycle) <br /> Facility/Site/011eration Data Entry Form <br /> O * * * New SWIS Number Update information ( * ❑ ) ElChange in address or phone #sE:lRequest to Archive <br /> CALRECYCLE USE ONLY=Facility/Site/Operation SWIS Number - - / LEA - <br /> ❑✓ * Facility Locator Information see : Minimum Data Required to Issue New SWIS Number <br /> Facility/Site Name : Riverbank City Dump <br /> Facility/Site Location/Address : 23707 s Santa Fe Rd. <br /> Nearest City/Place Name : Riverbank County: San Joaquin County State CA Zip : 95367 _ <br /> Facility locator info : Decimal Degrees = Longitude : - ❑ 1111 . ❑ 11111111 Latitude 1111 . 1111 ❑ ❑ ❑ <br /> -or- Degrees, Minutes, and Seconds : Long : - Lat: <br /> Assessor Parcel Number(s) : <br /> Map# : Section: Township : Range : Base/Meridian: <br /> ❑* Operator (Business Owner) Information <br /> Person/Operator Name/Company Name : <br /> Last Name: First Name: MI : <br /> Title : Organization: <br /> Mailing Address : <br /> City: State: Zip : ❑ ❑ ❑ ❑ ❑ — 1111 ❑ ❑ <br /> Phone Number : ( ❑ ❑ ❑ - ❑ ❑ ❑ ❑ FAX : ( ) [100 - ❑ ❑ ❑ ❑ <br /> E- Mail Address : <br /> ❑ * Land Owner(s) [Property Owner(s)] Information <br /> Person/Operator Name/Company Name : <br /> Last Name : First Name: MI: <br /> Title: Organization: <br /> Mailing Address : <br /> City: State : Zip : ❑ 111111 ❑ — ❑ 111111 <br /> Phone Number: ( ) ❑ ❑ 11 - ❑ ❑ ❑ ❑ FAX : ( ) 1111 ❑ - 0000 <br /> Email Address : <br /> * * *Required Signature for submittal to CalRecycle with supporting documents and maps . <br /> LEA or Operator or Owner signature : X f"J t� Phone: (209) 46&3526 Date: 08/11 /2023 <br /> 13 Supporting documents attache E3TAaps attached ❑All signatures and dates present on documents <br /> See : http ://www.calrecycle.ca.gov/SWFacilities/Directory/MinimumData.aspx <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> ❑ * Facility /Site / Unit: Characteristics /Specifications : <br /> Unit Activity(s) name(s) and Code #: <br /> (See back of this form for list of Activity types andcodes) <br /> Check one each: <br /> Regulatory Status Operator Type Operational Status Inspection Frequency: <br /> ❑Permitted ❑Federal ❑Planned Closure year (date) : <br /> ❑✓ Unpermitted ❑ State ❑Active Tons/Volume per Day: <br /> ❑Exempt ❑ County ❑Inactive Permit Date : <br /> ❑EA Notification ❑✓ City ❑✓ Closed EA Notification date : <br /> ❑Excluded ❑ Private ❑ Clean Closed <br /> ❑Proposed ❑District ❑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 #) <br /> * * *Required CalRecycle staff signature (Received and reviewed for completeness) <br /> by : Phone Date <br />