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ENFORCEMENT AGENCY NOTIFICATION <br /> Operation !Name: <br /> Address/Location: <br /> Phone Number- <br /> Operator: Land Owner: <br /> Mailing Address: Mailing Address: <br /> Phone Number. Phone Number: <br /> Operation Information: <br /> Authorizing Eiigibility(sec;bn of 14 CCR.otwston T.Chapter s or 111: <br /> Volume and Type of Waste/Materiai(s)Handled: <br /> Peak Loading: Cubic Yards or Tons <br /> .annual Loading: Cubic Yards or Tons <br /> -fours of Operation: <br /> I hereby certify under penalty of perjury that the information provided is true and accurate to the best of my knowledge and belief. <br /> Signature of Land Owner. Oate: <br /> Signature of Operator. Oate: <br /> ntorcement Agency Name and Address: FOR ENFORCEMENT AGENCY USE ONL.Y- <br /> Oate Received: <br /> scats : <br /> it <br /> Comnietion of-his loans not reaurrea by regulation,yowever.it-Anil orowde the enforcement agency with the,nfnrrnanon recutrad try'd C--R'8103.1. <br />