Facility/site/operation Data Entry Form

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Solid Waste Information System (SWIS)
State of California
California Department of Resources
Facility/Site/Operation Data Entry Form
CalRecycle 37 (Rev. 4/2016)
Recycling and Recovery (CalRecycle)
*** New SWIS Number
Update information (*
)
Change in address or phone #s
Request to Archive
CALRECYCLE USE ONLY=Facility/Site/Operation SWIS Number _____-_____-________ / LEA ____-____
* Facility Locator Information
see:
Facility/Site Name:________________________________________________________________________________
Facility/Site Location/Address:______________________________________________________________________
CA
Nearest City/Place Name:_________________________ County: ________________State ___
Zip:______-______




.
.
-
Facility locator info: Decimal Degrees = Longitude:
Latitude
-
-or-
Degrees, Minutes, and Seconds: Long:
_____________________ Lat: __________________
Assessor Parcel Number(s):_________________________________________________________________________
Map#:_______ Section:_______________ Township:____________ Range:_____________ Base/Meridian:________
* Operator (Business Owner) Information
Person/Operator Name/Company Name:_______________________________________________________________
Last Name:__________________________________________ First Name:__________________________________ MI:______
Title:____________________________________________ Organization:_____________________________________________
Mailing Address:___________________________________________________________________________________________
- 
:
City:______________________________________ State:___________________ Zip
- 
- 
)
Phone Number: (
FAX: (
)
E- Mail Address: _________________________________________________________________________________
* Land Owner(s) [Property Owner(s)] Information
Person/Operator Name/Company Name:______________________________________________________________________
Last Name:____________________________________________ First Name:________________________________ MI:______
Title:_______________________________________________ Organization:__________________________________________
Mailing Address:___________________________________________________________________________________________
- 
:
City:______________________________________________ State:___________________ Zip
- 
- 
Phone Number: (
)
FAX: (
)
Email Address: _______________________________________________________________________
***Required Signature for submittal to CalRecycle with supporting documents and maps:
Date
: X
LEA or Operator or Owner signature
________________________________________________________Phone:__________________
:____________
 Supporting documents attached
 Maps attached
 All signatures and dates present on documents
See
:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
* Facility /Site / Unit: Characteristics /Specifications:
Unit Activity(s) name(s) and Code #: _____________________________________________________________________________________________________
(See back of this form for list of Activity types and codes)
Check one each:
Inspection Frequency:______________________
Regulatory Status
Operator Type
Operational Status
Permitted
Federal
Planned
Closure year (date):________________________
Unpermitted
State
Active
Tons/Volume per Day:______________________
Exempt
County
Inactive
Permit Date:______________________________
EA Notification
City
Closed
EA Notification date:_______________________
Excluded
Private
Clean Closed
Proposed
District
To be Determined
List one or more Types of Waste to be received /permitted (see back of this form for list of waste types/ code #) :_______________________________________
***Required CalRecycle staff signature (Received and reviewed for completeness)
by: ________________________________________________
______________ Date_____________
Phone

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