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Part 8. OPERATOR INFORMATION (For disposal s it e ,if operat or isdifferentfrom l and owner,a ttach l ease orother agreement) <br />T Y P EE O FF B U S I N E S S :: <br />SS O L EE P R O P R I E T O R S HIPP P A R T N E R S HIPP C O R P O R A T I O NN G O V E R N M E N TT A G E N C YY <br />F A C IL IT Y O P E R A T O R (S) <br />(N a m e ):: <br />S S N O R T A X ID #: <br />A D D R E S S ,C I T Y ,S T A T E ,ZIP T E L E P H O N E #: <br />F A XX #:: <br />E -M A ILL A D D R E S S : <br />C O N T A C TT P E R S O NN (P r i n t N a m e ):: <br />A D D R E S SS W H E R EE L E G A LL N O T I C EE M A YY B EE S E R V E D :: <br />Part 9. SIGNATURE BLOCK <br />Owner: <br />Icertif y under penal tyof perjury thatthe i nformation I provided for th isapplicati on and for any attachment s i s true and accurat e t o t he best of my knowl edge and belie f.Iam <br />aware thatthe operator i nt ends t ooperat easolidwaste f acilityatthe sit especifi ed above pursuantto th isapplication and underst and t hat I may be responsi bl e for the sit e <br />should the operat or f a il t omeet applicabl erequirement s . <br />S I G N A T U R EE (L A N DD O W N E RR O RR A G E N T): <br />PP R I N T E DD N A M E :: <br />TIT L E :: D A T E : <br />Lessee: <br />Icertif y under penal tyof perjury thatthe i nformation I provided for th isapplicati on and for any attachment s i s true and accurat e t o t he best of my knowl edge and belie f.Iam <br />aware thatthe operator i nt ends t ooperat easolidwaste f acilityatthe sit especifi ed above pursuantto th isapplication. <br />S I G N A T U R EE (L E S S E E ):: <br />PP R I N T E DD N A M E :: <br />TIT L E :: D A T E : <br />Operator: <br />Icertif y under penal tyof perjury thatthe i nformation cont a ined i n t hi sapplication and all a ttachment saretrue and accurat e to the best o f my knowl edge and belie f. <br />S I G N A T U R EE (F A C IL I T YY O P E R A T O RR O RR A G E N T): <br />PP R I N T E DD N A M E :: <br />TIT L E :: D A T E :: <br />Part 10. OTHER (Attach additi onal sheet s toexpla inanyresponsesthat need cl arificati on). <br />Page 4 <br />h e i nform a tio n I pro v id e d for th is a p p l i c a ti o n a n d for a n y a t t a c h m e n t s i s tr <br />e r a t e a s oli d w a s t e f a cility a t th e s it e s p e c ifi e d a b o v e p urs u a n t t o th is a p p <br />D A T E : <br />ru e a n d a c c ura t e t o t h e b e stttttt of m y k n o w l e d g e <br />p lic a tio n . <br />D A T E : <br />h e i nform a tio n c o n t a in e d i n t hi s a p p lic a tio n a n d a l l a t t a c h m e n t s a re tru e a <br />A G E N T): <br />a n d a c c ur a t e to th e b e s t o f m y k n o wl e d g e a n d <br />✔ <br />County of San Joaquin, Public Works Department - Solid Waste Division 946000531 <br />San Joaquin County <br />Department of Public Works <br />Attention: Solid Waste Division <br />1810 E Hazelton Ave. <br />Stockton, CA 95205 <br />2094683066 <br />2094683078 <br />MHoughton@SJGov.org <br />Mark Houghton <br />County of San Joaquin, Public Works Department <br />Bryce Howard <br />Integrated Waste Manager <br />County of San Joaquin, Public Works Department - Solid Waste Division <br />Bryce Howard <br />Integrated Waste Manager