Laserfiche WebLink
Part 8. OPERATOR INFORMATION(For disposal site,If operator is different from land owner,attach lease or other agreement) <br /> TYPE OF BUSINESS: <br /> ElSOLE PROPRIETORSHIP PARTNERSHIP �X CORPORATION GOVERNMENT AGENCY <br /> FACILITY OPERATORS) SSN OR TAX ID#: <br /> (Name): <br /> Mike Repetto #680293953 <br /> ADDRESS,CITY,STATE,ZIP TELEPHONE#: <br /> 30703 S. MacArthur Drive,Tracy, CA 95376 <br /> 209 835.0601 <br /> FAX#: <br /> 209)835-7729 <br /> E-MAIL ADDRESS: <br /> mikerOAdswm.com <br /> CONTACT PERSON(Print Name): <br /> Mike Repetto <br /> ADDRESS WHERE LEGAL NOTICE MAY BE SERVED: <br /> 30703 S. MacArthur Drive,Tracy, CA 95376 <br /> Part 9.SIGNATURE BLOCK <br /> Owner: Mike Repetto <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 am <br /> 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 site <br /> should the operator fail to meet applicable requirements, <br /> SIGNATURE(LAND OWNER <br /> /ORRR AGENT): <br /> PRINTED NAME: <br /> Mike Repetto <br /> TITLE: Director DATE: <br /> Lessee: n1a <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 am ', <br /> aware that the operator intends to operate a solid waste facility at the site specified above pursuant to this application. '.. <br /> SIGNATURE(LESSEE): <br /> PRINTED NAME: i <br /> TITLE: DATE: <br /> Operator: Mike Repetto <br /> I certify under penalty of perjury that the Information contained in this appllcatlon and all attachments are true and accurate to the best of my knowledge and belief. <br /> SIGNATURE(FACI TY OP TOR OR AGENT): <br /> PRINTED NAME: <br /> Mike Repetto <br /> TITLE: Director DATE: /a Z� <br /> Part 10.OTHER (Attach additional sheets to explain any responses that need clarification). <br /> Page 4 <br />