Laserfiche WebLink
Part S.OPERATOR INFORMATION(For disposal site,H operator is different from landowner.attach lease or other agreement) <br /> TYPE OF BUSINESS: <br /> ®SOLE PROPRIETORSHIP DPARTNERSHIP EX CORPORATION —®GOVERNMENT AGENCY <br /> FACILITY OPERATOR(S) SSN OR TAX to C <br /> (Name): <br /> Forward, Inc. 941544481 <br /> ADDRESS,CITY.STATE,ZIP TELEPHONE 9 <br /> 209-982-4298 <br /> FAX N: <br /> 209-982-1009 <br /> 9999 S. Austin Road, Manteca,CA 95336 E-MA L ADDRESS <br /> EFanning@republicservices.com <br /> CONTACT PERSON(Prml Name): <br /> Erin Fanning <br /> ADDRESS WHERE LEGAL NOTICE MAY BE SERVED; <br /> 9999 S.Austin Road,Manteca,CA 95336 <br /> Part 9.SIGNATURE BLOCK <br /> Owner: <br /> I certify under penalty of perfury 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 appi cation and understand that I may be responsible for the <br /> site should the operator fail to meet appillcable requirements. <br /> SIGNAT�PE(LAND OWN6 OR AGENTI <br /> Kevin Basso <br /> PRINTED NAME: <br /> General Manager <br /> TITLE: DATE <br /> Operator: <br /> I certify under pen tf partury_lharrhe information contained in this application and all attachments are true and accurate to the best of my knowledge and belief. <br /> SPI60d9E(FAC!V6 OPERATOR OR AGENT) <br /> Kevin Basso <br /> PRINTED NAME: <br /> General Manager <br /> TITLE: DATE* <br /> Part 10.OTHER (Attach additional sheets to explain any responses that need clarification). <br /> Page 4 <br />