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Jun. 14. 2005 115P H FARMS No. 1002 P. 2 <br /> State of CdliifDDmia 0 California Integrated Waste <br /> CIWMB 675(New 10/02) Manag®ment Board <br /> 45-DAY OWNER OR OPERATOR TRANSFER NOTICE <br /> Owner Transfer; ® Operator Transfer: 0 <br /> (mark ane or both) <br /> Information Required on Notification for a Change of Owner or Operator at a Solid Waste Facility(PRG, Section 44005) <br /> FACILITY/$ITE INFORMATION <br /> Facility Name: . }. :: C, tat S.. SWIS U <br /> X Address/Location: ° ,�1►y ' <br /> Phone Number.-2;Q1 J ' <br /> y OWNIE=RIOPERATOR INFORMATION <br /> New Operator.Pak k : ,'f'1f1.$ New Land owner:�. imLA ,. <br /> Mailing Address' Mailing Address: <br /> �.. 4L <br /> Phone Number O`�•' 9 Phone Number' { <br /> Date of Anticipated Transfer: <br /> OPERATION INFORMATION(Complete if facility is a solid waste landfill) <br /> 1. Submitted Closure&Postclosure Mali enance Plan(C&PMP): Preliminary 0 Final Q <br /> Approval Dake for Revised C MP (per Title 27,CCR,Section 21890): <br /> 2. Approval Date of Amended F' andal Assurances Demonstration: <br /> Financial Assurances r Title 27,CCR,Articles 9 &2): <br /> Operating Liability er Title 27, CCR,Article 3): <br /> Report of Faci' nformation (RFI) <br /> Governing CAmfent Design&Operation: Date <br /> rlhp� <br /> n: <br /> ceHy of perjury.thethq,irifcimotion-provided is,rtie and oppV&to the Best of my knowledge and, <br /> rthettY a Thereby rbfy:that'(aseume entirely;.ffre faaliljr dasigiti and o S d in the ourrent•RFI;that <br /> be no physic$14hangove:and beyond,what Ts desciibed'in the:RFI;and thot th®faclllty w[I1 be operated in' <br /> e.with the"s'.'and t�nditiottsof the'approved perink and a>I.othera'ppinature of Land Owner. Date:Signature of Operato . Date: .. <br /> Completion of this form is not required by regulation. [twill provide the CIWM8 and FA with the information required by PRC,Section 44005. <br />