Laserfiche WebLink
A. <br /> ENFORCEMENT AGENCY NOTIFICATION <br /> Operation Name: y z o ma. M S <br /> Address/Location: FILE C <br /> Phone Number: <br /> Operator: r r» ,�5,L Land Owner: 46 rvn All <br /> Mailing Address: Mailing Address: <br /> �- a33S4 33S <br /> q5g3 otic /lam 4�a . � s69 3 <br /> Phone Number: q�`j 6�7 7 Phone Number: �fi6 6 �7 7 Jy <br /> Operation Information: <br /> Authorizing Eligibility(Section of 14 CCR,Division 7,Chapter 3 or 3.1): <br /> Volume and Type of Waste/Material(s)Handled: /. �� /r`/ Y�ct✓/d{�-�, <br /> Peak Loading: ubic Yard or Tons <br /> Annual Loading: ubic Yard or Tons <br /> yrn yM <br /> Hours of Operation: �7 5 <br /> I hereby certify under penalty of perjury that the information provided is true and accurate to the best of my knowledge and belief. <br /> Signature of Land Owner: Date: <br /> Signature of Operator: Date: <br /> Enforcement Agency Name and Address: FOR ENFORCEMENT AGENCY USE ONLY <br /> Date Received: <br /> SWIS#: <br /> 'Completion of this form is not required by regulation,however,it will provide the enforcement agency with the information required by 14 CCR 18103.1. <br />