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State of California Department of Resources Recycling and Recovery(CalRecycle) <br /> Clear Print <br /> PLEDGE OF REVENUE REQUIREMENTS <br /> NOTE:This form is the transmittal sheet for documents required to be submitted to CalRecycle for a Pledge of Revenue as specified in Title 27,California Code of <br /> Regulations,Division 2,Subdivision 1,Chapter 6. Please refer to the instructions for definitions of terms and for completing this form. <br /> Part 1. OWNER/OPERATOR ESTABLISHING PLEDGE OF REVENUE <br /> Check one box only <br /> ❑X OWNER OPERATOR <br /> OWNER/OPERATOR NAME(Type or Print) NAME OF CONTACT FOR PLEDGE OF REVENUE(Type or Print) <br /> San Joaquin County Department of Public Works Juan Acevedo <br /> ADDRESS,CITY,STATE,ZIP ADDRESS,CITY,STATE,ZIP <br /> 1810 E. Hazelton Ave 1810 E. Hazelton Ave <br /> Stockton, CA 95201 Stockton, CA 95201 <br /> TELEPHONE#: TELEPHONE#: <br /> (209) 468-3066 (209) 953-7316 <br /> FAX#: FAX#: <br /> (209) 468-3078 (209) 468-3078 <br /> E-MAIL ADDRESS: E-MAIL ADDRESS: <br /> MHoughton@SJGov.org JGAcevedo@sj gov.org <br /> Part 2. PLEDGE OF REVENUE <br /> PLEDGE OF REVENUE AGREEMENT FOR:(Check applicable boxes): ANNUAL PLEDGED REVENUE <br /> [Ell. POSTCLOSURE MAINTENANCE COSTS 1$ 277,607 <br /> XZ2. CORRECTIVE ACTION COSTS 1$ 38,533 <br /> 1:13.BOTH(COMBINED COSTS AS WELL AS COSTS IDENTIFIED ABOVE) Is <br /> Part 3. LIST OF ATTACHMENTS (Fill in for each document and attach a copy) <br /> REQUIRED WITH ALL PLEDGE OF REVENUE SUBMITTALS: <br /> R-08-687(1/27/09)R-08-686(12/9/08) 1. RESOLUTION BY GOVERNING BODY A-94-434 (5/4/93) 2. PLEDGE OF REVENUE AGREEMENT DATE <br /> (Date and Resolution Number) <br /> 3. DATE OF ANNUAL CERTIFICATION OF CONTINUED AVAILABILITY OF PLEDGED REVENUE(See Instructions) <br /> Part 4. SIGNATURE BLOCK <br /> OWNER/OPERATOR ESTABLISHING PLEDGE OF REVENUE <br /> I certify under penalty of perjury that the information provided in this form and any attachments is true and correct to the best of my knowledge and belief. <br /> SIGNATURE: <br /> PRINTED NAME: <br /> Mark Houghton <br /> TITLE: Senior Civil Engineer DATE: 5/31/23 <br /> Part 5. OTHER (Attach additional sheets to explain any responses that need clarification). <br /> CalRecycle 114(02/2010) Page 2 of 3 <br /> State of California Department of Resources Recycling and Recovery(CalRecycle) <br />