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AUTHORITY: Public Resources Code section 43600 et seq. <br />-PURPOSE; The Information provided will be used to verVy adequate financial assurance of solid waste <br />A disposal facilities listed, <br />REQUIREMENT: Completion of this form Is mandatory. The consequence of not completing this form is <br />dental or revocation of a permit to operate a solid waste disposal facility. <br />OTHER INFORMATION; After review of this document, you may be requested to provide additional <br />Information regarding the acceptability of this mechanism. <br />ACCESS: Information provided in this form may be provided to the U.S. Environmental Protection <br />Agency, State Attorney General, Air Resources Board, California Department of Toxic Substances <br />Control, Energy Resources Conservation and Development Commission, Water Resources Control <br />Board, and California Regional Water Quality Control Boards, For more information or access to your <br />records, contact the California Integrated Waste Management Board, 8800 Carl Center Driver <br />Sacramento, CA 95826. (916) 255-2200, <br />U <br />isCA- SOLID WASTE -GPC (1/00) Page 3 <br />CIWMB 106 (4/96) <br />