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State of California California Integrated Waste CIWMB 675(New 10/02) Management Board 45-DAY OWNER OR OPERATOR TRANSFER NOTICE Owner Transfer: ❑ Operator Transfer: kN (mark one or both) Information Required on Notification for a Change of Owner or Operator at a Solid Waste Facility(PRC, Section 44005) FACILITY/SITE INFORMATION Facility Name: 61-0 - W > ,dj SWIS#: Address/Location: 41.31/3 1Zf e n 6 Phone Number: - V93,' OWNER/OPERATOR INFORMATION n 01' e New Operator: 6/v / 'ezt 13fL"Oe4ew Land Owner: Mailing Address: Mailing Address: Z13 4'3 �► !S d Phone Number: f f) 8 - V736 Phone Number: Date of Anticipated Transfer: </,g Z0 f OPERATION INFORMATION (Complete if facility is a solid waste landfill) 1. Submitted Closure& Postclosure Maintenance Plan (C&PMP): Preliminary ❑ Final El Approval Date for Revised C& PMP (per Title 27, CCR, Section 21890): 2. Approval Date of Amended Financial Assurances Demonstration: Financial Assurances (per Title 27, CCR,Articles 1 &2): Operating Liability(per Title 27, CCR,Article 3): Report of Facility Information(RFI) Governing Current Design&Operation: Date Certification: I hereby certify under the penalty of perjury that the information provided is true and correct to the best of my knowledge and belief. Furthermore,I hereby certify that I assume entirely,the facility design and operations described in the current RFI;that there will be no physical changes above and beyond what is described in the RFI;and that the facility will be operated in compliance with the terms and conditions of the approved permit and all other applicable requirements:' Signature of Land Owner: _ Date: Signature of Operator. Date: -7- 102-01 Completion of this form is not required by regulation. It will provide the CIWMB and EA with the information required by PRC,Section 44005.