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Owner or Authorized Agent: <br />Greq Kamper <br />Print Name <br />Signature <br />i <br />Angelina Kamper <br />Print Name <br />Si na re <br />Richard Kamper, Trustee <br />Print e <br />Signature <br />Brenda Carole Kamper, Trustee <br />Print Name <br />Signature <br />Date i <br />Owner l <br />Title <br />—/'� <br />Date <br />Owner <br />Title <br />Date <br />s <br />Owner <br />Title <br />Date <br />Owner l —1 �' —� '7 <br />Title <br />F:\Devsys/Planning Application Forms 2005-92 HazMat Disclosure <br />Hazardous Materials Disclosure Survey (Revised 8-25-03) Job No. 2005-92 Page 2 of 2 <br />