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JUL 01 '92 07:50 DIT_ MRtJTECR__ _ - p.3. <br /> FACILITY NAME: O <br /> ID No.: �}1000�5�6 /a <br /> (See Instructions on reverse) <br /> IX. FACILITY OPERATOR NAME <br /> i <br /> C-77t a,r) ( G .. <br /> C. <br /> 'X. FACILITY OPERATOR ADDRESS <br /> �/o,o ra.nr, crn ar anRK 42 js <br /> (Atltlr•q) <br /> rc rv) wam) 3 <br /> czar Ctla•) <br /> XI. FACILITY OPERATOR TELEPHONE NUMBER <br /> 09 - meq _ y <br /> cA' I Otl•tlntl Numpw� <br /> XII. DESCRIPTION OF SPECIFIC WASTE TYPE(S) TREATED (Use only the space provided) <br /> u4 '— <br /> E'iY�Zi <br /> XIII. DESCRIPTION^OF TREATMENT PROCESS(ES) USED (Use only the space provided) <br /> 2�-{ /TU Tu•Trunk n)e..'�C IT ..� � /' <br /> XIV. OPERATOR CERTIFICATION <br /> It Is my intention to operate the above facility under Permit-By-Rule for Fixed Treatment Units <br /> pursuant to Title 22, California Code of Regulations. Section 67450.2(b). <br /> I certify under penalty of low that this document was prepared under my direction or supervision in <br /> accordance with o system designed to assure that qualified personnel properly gather and <br /> evoluate the information submitted. Based on my inquiry of the person or persons who manage <br /> the system, or those directly responsible for gathering the Information, the Information is, to the <br /> best of my knowledge and belief, true, accurcte, and complete. I am aware that there are <br /> signlficant penalties for submitting false Information, Including the possibility of fines and <br /> Imprisonment for knowing violations. <br /> a <br /> �S nn n— -� Ori r. }'KQSLL�c.77e..•>rCi <br /> f--care'''111— <br /> -T • pn• <br /> Drstrtdution: DrSC—White and Yellow; NoliRer—Pink and Instructions <br /> iC$442(11,91) <br /> Page 2 0!2 <br />