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The parties below certify and sign under penalty of perjury that the information in thisdocument is true and correct <br /> to.the best of his or her knowledge,and that this document is being executed in accordance with the requirements of <br /> Title 14,California Code of Regulations,Division 7,Chapter 5,.Article 3.37 Section 18237. <br /> Operator's.Signature. Title <br /> Integrated Solid Waste Manager <br /> Typed or.Printed Name of Person gning Date. <br /> Annette.Borges. <br /> Risk Manager's Signature Title. <br /> Risk Manager <br /> Typed or Printed Name.of Person Signing Date r <br /> Richard Pietz <br /> PRIVACY STATEMENT. <br /> This information is requested by the.California Integrated Waste Management Board under Title.14,California <br /> Code.of Regulations,Division 7,Chapter.5,Article.3.3,Section 18237.in order to.verify adequate.financial <br /> assurance of solid waste disposal facilities. Completion of this form is mandatory..The consequence.of not <br /> completing this form is denial or revocation of a permit tooperate.solid waste disposal faeility. Information may be. <br /> provided to.the U.S.Environmental Protection Agency,State.Attorney.General,Air Resources Board,California <br /> Department of Toxic.Substances Control,Energy Resources Conservation and Development Commission,Water. <br /> Resources Control Board,and California Regional Water Quality Control Boards.. For more information or access. <br /> to your records,contact the California Integrated Waste.Management Board, <br /> 8800.Cal Center Drive,Sacramento,California 95826,(916)255-2200_ <br /> FmmCIWMB 133.(11/91) PAGE2OF.2 <br /> N:Wliscellaneous\ClosCosEst\CIWMSSelf-insurance Cel doc <br />