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Part 8.OPERATOR INFORMATION (Fp dl,po,al ldp......I.diffarentfrpm land p n e.M1 LaS.p dthlr agr.em.n[) <br /> TYPE OF BUSINESS: <br /> 11 SOLE PROPRIETORSHIP PARTNERSHIP CORPORATION GOVERNMENT AGENCY <br /> FACILITY OPERATOR(S) SSN OR TAX ID P. <br /> (N...): <br /> ADDRESS,CITY,STATE,ZIP TELEPHONE#: <br /> FAX A <br /> E-MAIL ADDRESS: <br /> CONTACT PERSON(Prim N.m.): <br /> ADDRESS WHERE LEGAL NOTICE MAY BE SERVED: <br /> Part 9.SIGNATURE BLOCK <br /> Owner: <br /> I.artily untler penalty of pe Jury th.t th,Inform,tion 1 ,—c—for[his appllc,tion end for any It-- &I—, end accurate[o Che bas[of my knowledge and bellef. I am <br /> aware 1M1 et th.o p.r.t.r--d.tend.to opera to a solid west,-1111[y etch.zit,specified above pursuant[,thla eppll etlo,end untl erste Id[ha(I may ba responsible forth.alta <br /> uld tM1a operator fall[ eppll.e ble req ulra mens. <br /> SIGNATURE(LAND OWNER OR AGENT): <br /> PRINTED NAME: <br /> TITLE: DATE: <br /> Lessee: <br /> I de Ify under pa n.Ity of pprfuly[h e[th.Inform at—I pro vltletl for ti,lz eppllca[lon and for any alta ch m e n[s Is true 1 I accurate[o the best of my knowletl ge entl ballet. am <br /> [ha[[he opere[dl Intends t operate a olid w III raclllty It zlt,sp I11flId a a pursue It I, application. <br /> SIGNATURE(LESSEE): <br /> PRINTED NAME: <br /> TITLE: DATE: <br /> Operator: <br /> I c I.wy untler penally of pe Jury t the atlon—t. —d In tM1iS eppllca[lon end ell a ntl a my knowledge entl belief. <br /> SIGNATURE(FACILITY OPERATOR OR AGENT): <br /> PRINTED NAME: <br /> TITLE: DATE: <br /> Part 10.OTHER (Atte.h additional 11,11[5[o.splaln .ny—p I n.es[Mat need clarlfle acid n). <br /> Page 4 <br />