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Part 8.OPERATOR INFORMATION(For disposal site,H operator Is different from landowner.attach lease or other agreement) <br /> TYPE OF BUSINESS: <br /> ®SOLE PROPRIETORSHIP PARTNERSHIP ®CORPORATION EIGOVERNMENTAGENCY <br /> FACILITY OPERATOR(S) SSN OR TAX ID tk. <br /> (Name): 14 <br /> YI0L)Aj COP-POP-6r16A1 31 - i25451 ,9 <br /> ADDRESS,CITY,STATE,ZIP TELEPHONE 0: <br /> t� RIA . <br /> 2o3- 067- 304-5 <br /> 2S� FLC)O,. Rd . FAX A: <br /> CINd, -io I C z09- <br /> E-MAIL ADDRESS: <br /> bi �14t. bULCGA) k, 5CO 0Iq <br /> CONTACT PERSON(Print Name): <br /> P P-e JT got-TORI <br /> ADDRESS VMERE LEGAL NOTICE MAYBE SERVED: <br /> Z3390 FL.®tici Rck ./ LwlffAj, CA qsz :36 <br /> Part 9.SIGNATURE BLOCK <br /> Owner: <br /> I certify under penalty of perjury that the Information I provided for this application and for any attachments Is true and accurate to the best of my knowledge and belief. I <br /> am aware that the operator(Mends to operate a solid waste Willy at the site specified above pursuant to this application and understand that 1 may be responsible for the <br /> site should the operator fail to meet applicable requirements. <br /> SIGNATURE(LAND OWNER OR AGENT): <br /> PRINTED NAME: <br /> duo gLt�x' .2/ G 7 <br /> TITLE: DATE: <br /> Operator: <br /> I certify undo pens of perjury that the information contained In this application and all attachments are true and accurate to the best of my knowledge and belief. <br /> SIGNATURE(FACILITY OPERATOR OR AGENT): .' <br /> r?46k,-r 1&0L_te <br /> PRINTED NAME: <br /> TITLE: DATE: <br /> Part10.OTHER (Attach additional sheets to explain any responses that need clarification). <br /> Page 4 <br />