Laserfiche WebLink
MEN- <br /> Part a.OPERATOR INFORMATION(For disposal site,it operator Is different from land owner,attach lease or other agreement( <br /> TPE OF BUSINESS: <br /> SOLE PROPRIETORSHIP ®PARTNERSHIP IX CORPORATION GOVERNMENT AGENCY <br /> SSN OR TAX ID p <br /> =ACt11TY OPERATOR(SD <br /> Nam).' 941544481 <br /> Forward,Inc. <br /> TELEPHONE a <br /> ADDRESS,CITY,STATE,21P <br /> 209-9824298 <br /> Axa <br /> 209-982-1009 <br /> -MAILADDRE : <br /> 9999 S.Austin Road, Manteca*CA 95336 <br /> dlitGhfieidtr rub licse rvids.com <br /> CONTACT pERSON(Pnnt Name): <br /> Don Litchfield <br /> ADDRESS WHERE LEGAL NOTICE MAY BE SERVED <br /> 9999 S.Austin Road,Manteca,CA 95336 <br /> Part 9.SIGNATURE BLOCK <br /> Owner: <br /> I certify under penalty of perjury that the Information i provided for this apprito sp m and for any attachments true and accurate to the best of my knowledge and belief f <br /> specified above pursuant this <br /> s abl anon and understand that i may be responsible for the <br /> am aware that the operator Intends to operate a solid waste facility at the silo s <br /> site should the op allapplicable requirements. <br /> S <br /> �;EM(LAND �ERORGENTR <br /> Kevin Basso <br /> PRINTED NAME. <br /> General Mananer <br /> DATE; <br /> TirLE: �—C/J r 3 <br /> erator: / r <br /> I certify under penalty f perjury that the Information contained in this application and all attachments are true and accurate to the best of my knowledge and belief. <br /> ORE(FACILITY RATORORAGENT): <br /> Kevin Basso <br /> PRINTED NAME <br /> General Man @t DATE; <br /> Tine <br /> Part 10.OTHER (Attach additional sheets to explain any responses that need clarification), <br /> Page 4 <br />