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State of California Solid Waste Information System (SWIS) Department of Resources Recycling <br /> CalRecycle 37(Rev.12/17) and Recovery(CalRecycle) <br /> Facility/Site/Operation Data Entry Form <br /> ❑***New SWIS NumberZ Update information (*❑ )OChange in address or phone#s]Request to Archive <br /> CALRECYCLE USE ONLY=Facility/Site/Operation SWIS Number 39 _CR -6 /LEA <br /> ❑* Facility Locator Information see: Minimum Data Required to Issue New SWIS Number <br /> Facility/Site Name:F&w Cattle Co <br /> Facility/Site Location/Address: 19043 S.McKinley Ave <br /> Nearest City/Place Name:Manteca County:San Joaquin State CA Zip:95336 _ <br /> Facility locator info: Decimal Degrees=Longitude: - ❑ ❑ ❑.❑ ❑ 1111 ❑ Latitude 1111 . 1111 ❑ ❑ ❑ <br /> -or- Degrees,Minutes, and Seconds: Long:- Lat: <br /> Assessor Parcel Number(s): <br /> Map#: Section: Township: Range: Base/Meridian: <br /> 0* Operator(Business Owner)Information <br /> Person/Operator Name/Company Name: <br /> Last Name:Smith First Name:Erick MI: <br /> Title: Organization:Glenn Charles Investments LLC <br /> Mailing Address: 1919 Grand Canal Blvd C-7 <br /> City:Stockton State:CA -Zip: 0 0 ❑2 ❑0 7❑— ❑ ❑ ❑ ❑ <br /> Phone Number: (209 �- ® Q FAX:( ) ❑ ❑ ❑- 111111 ❑ <br /> E-Mail Address: erick@kyhc.org <br /> Z* Land Owner(s) [Property Owner(s)]Information <br /> Person/Operator Name/Company Name: <br /> Last Name:Smith First Name:Erick MI: <br /> Title: Organization Glenn Charles Investments LLC <br /> Mailing Address:1919 Grand Canal Blvd C-7 <br /> City: Stockton State:CA Zip: 9❑ ❑5 ❑2 0 Q— ❑ ❑ ❑ ❑ <br /> Phone Number: (209 ) 0 0 Q_ ® ❑1 0 FAX: ( ) 000— DEME <br /> Email Address: erick@kyhc.org <br /> ***Required Signature for submittal to CalRecycle with supporting documents and maps: <br /> LEA or Operator or Owner signature: X 1- - � Phone 1209)468-3854 Date;12/27/2022 <br /> ®Supporting documents attached ❑Maps attached ❑All signatures and dates present on documents <br /> See httn://www.calrecvcle.caeov/SWFacilities/Directory/Ntininrun,Data.asnx <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:Quartedy <br /> ❑Permitted ❑Federal ❑Planned Closure year(date): <br /> OUnpermitted []State ❑Active TonsNolume 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 />