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TYPE OF BUSINESS,. <br /> 0 SOLE PROPRIETORSHIP PARTNERSHIP CORPORATION D GOVERNMENT AGENCY <br /> FACILITY OPERATOP431 SSN OR TAX to t- <br /> IN—): USA Waste of California Inc.dba Central Valley Waste Services 68-0306154 <br /> ADORES%CITY,STATE,ZIP TELEPHONE <br /> 1333 East Tumer Road, P.O. Box 241001, Lodi, CA 95241 209-333-VA4 <br /> FAX <br /> E4L4JL ADDRESS: oineda@M.com <br /> CONTACT PERSON(Print Name): <br /> Gilbert Pineda <br /> ADDRESS WHERE LEGAL NOTICE MAY BE SERM., <br /> 1333 East Turner Road,P.O.Box 241001,Lodi,CA 95241 <br /> Part 9.SIGIRTME OEM <br /> Owner. <br /> I certify under penalty of paqury that the information I provided for this application and for any aftachatents Is true and accurate to the best of ary knowhKlp and beW- I am <br /> aware that the operator Intends to tea solid waste facility at the sites above Mutant to Oft application and understand that I may be responsible for the site <br /> should the Operator fall to mest applicable requirements. <br /> SIGNATURE MMD OVWMR OR AGENT). <br /> .,elf <br /> PRINTED <br /> NAME: <br /> TITLE:. DATE- <br /> Lessee: <br /> aware that Um operator intends to operate a solid waste facility at the site specified above pursuant to this application. <br /> SIGNATURE(LESSEE): <br /> PRINTED NAME: <br /> TITLE: DATE: <br /> Operator. <br /> I certify under penalty of petlury that the Information contained In this application and all anachmenis are true and accurate to the best of rny knowledge and bdd. <br /> SIGNATURE(FACILITY OPERATOR OR AGENT): <br /> P NAME <br /> ' 6!1 4e-P44- <br /> 11TI.L. DATE* L <br /> 71, 1'7 <br /> Page 4 <br />