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Part 8.OPERATOR INFORMATION(For disposal site,if operator is different from land owner,attach lease or other agreement) <br /> TYPE OF BUSINESS: <br /> DSOLE PROPRIETORSHIP PARTNERSHIP OCORPORATION MGOVERNMENTAGENCY <br /> FACILITY OPERATOR(S) SSN OR TAX ID#: <br /> (Name): <br /> ADDRESS,CITY,STATE,ZIP TELEE'PPHH'O`'N�E�#t: <br /> 1 - ` ��Y FAX#: 5' G <br /> E-MAIL ADDRESS: <br /> � yjCy <br /> CONTACT PERSON(Pnn Name): <br /> ADDRESS WHERE LEGAL NOTICE MAY BE SERVED: <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 intends to operate a solid waste facility at the site specified above pursuant to this application and understand that I may be responsible for the <br /> site should the operator fail to meet applicable requirements. <br /> SIGNATURE(LAND OWN AGENT): <br /> PRINTF E: y n <br /> t� <br /> TITLE: �- 1 1 Cr DATE: �D / <br /> Operator: <br /> I certify under penalty 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 TOR OR AGE <br /> PRINT <br /> .i n <br /> TITLE: DATE: DL j17 <br /> Part 10.OTHER (Attach additional sheets to explain esponses that need clarification). � <br /> Page 4 <br />