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07/12/02 FFRRII114:18 FAX 510 287 0621 EBNGD 501x(,6 1,1:L " <br /> TRUCKED NON-IIAZARDOUS WASTE DISPOSAL PERMIT <br /> ,J Terms and Conditions <br /> EDMUD APPLICANT INFORMATION <br /> APPLICANT HUSfNESS NAME PERM IT NVMaER <br /> co LLC aatii <br /> APPLIC14AWLINGADDRESSS <br /> /zy70 2411 <br /> 9T.EiT ADaee LS <br /> coq 9Sz37 <br /> CITY 7sr CODE <br /> PERSON TO BECONTACI£/DJREGARDINOTHIS APPLICATION <br /> NAMt nrlE <br /> CZli ) 7z7- 9770 C1v5) 7z7- 2773d �i�L_&Qo coevl <br /> PHOA NUMQU IAn NUMEeI UL6CTAaNtCMA1L(E-MAIL) <br /> BROENCY CONTACT <br /> 'it 41 41d <br /> NAME <br /> Cz6�) 7z7- '7776 ) 7z7- 9770 6�KM3-6sas <br /> DAY PHONE NUMYEA NIOIR PNOr4 NuMlel CELLULAR PRONG NUMRLe <br /> Ozeil 747- 1773 Ins) I`ri3 ' c2Sa <br /> rA.NUM)rs PAGER NUMDEA <br /> CERTIFICATION <br /> I understand that f am legally responsible far the disposal of Trucked non-hazardous waste and for complying with the Terms and <br /> Condition,of ilia 11Tueked Non-Hazardous Waste Disposal permit(Fermi(!,and hereby carp that hazardous waste to defined in <br /> Stenon SSI17 of the California Heoltb and Safety Code shall not be disposed. I understand thol disposal of trucked non-hazardau <br /> wmrte, as described in fhit Perri a subject to KNAlUD Wasrewater OperatfOns Dtvisfon cnndioons. <br /> I caritfy under penalty of law that this document and all attachmenu were prepared under my dfrectian or suparvisfon in <br /> accordance wu/r a system dasignad to assure that Qualified personnel properly gotAer and evaluate the Llfoimation submitted. <br /> Based on.my inquiry of the person or persons who u+auage the•rystem,or those parsons firucdy sesponsiblo fw gad,eling <br /> igformollon,the information submitted Ls, to The bx f of my knuwlelge and belief. true.ac.mrase,and complete, t am aware iAni <br /> there are significant penaftle,for submiffing false information, including the pouibiliry affne and imprisonment for knowing <br /> Walston, <br /> J � TIYLE <br /> NAMC " <br /> 9 0NA <br /> DATE <br /> (To la slemzo lY Over Caecu OlsKu OKDvi.Y Au"100 EO RurISCNYATIvE• 9EEf9RntlCnnam luiOvi/LMaTsmt ucvesse) <br /> Rc.ired EtJ9NI <br /> Z00® TSJ 3JBt10S fl:1Mfl3 IZ90 L97 OTS XVd ZZ:TT 03..6 ZO/CO/LO <br />