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Par t 8. O PE RA T OR INFO RM A T IO N (For disposal site, if operator is different from land owner, attach lease or other agreement) <br />TYPE OF BUSINESS: <br /> SOLE PROPRIETORSHIP PARTNERSHIP X CORPORATION GOVERNMENT AGENCY <br />FACILITY OPERA TOR(S)SSN OR TAX ID #: <br />(Name): <br />ADDRESS, CITY, STATE, ZIP TEL EPHONE #: <br />FAX #: <br />E-MAIL ADDRESS: <br />CONTACT PERSON (Pr int Nam e): <br />ADDRESS WHERE L EGAL NOTICE MAY B E SERVED: <br />Par t 9. S IG NA TUR E B L O CK <br />Ow n er : <br />SIGNATURE (LA ND OWNER OR AGENT): <br />PRINTED NAME: <br />TITL E:DATE: <br />L es s ee: <br />SIGNATURE (LESSEE): <br />PRINTED NAME: <br />TITL E:DATE: <br />Op er at o r : <br />SIGNATURE (FA CILITY OPERATOR OR A GENT): <br />PRINTED NAME: <br />TITL E: <br />Par t 10. O TH ER (Attach additional sheets to explain any responses that need clarification). <br />9999 South Austin Road, Manteca, CA 95336 <br />Kevin Basso <br />kbasso@republicservices.com <br />(209) 982-4298 <br />Forward Inc.65-0716904 <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 />Kevin Basso <br />General Manager <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 />General Manager DATE: <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 />Kevin Basso <br />Page 4 <br />04/06/2022 <br />04/06/2022