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TRUCKED NON-HAZARDOUS WASTE DISPOSAL PERMIT <br /> Tertr,v and Conditions <br /> EBMUD APPLICANT INFORMATION <br /> APPLICANT BUSINESS NAME PERM I T NLrmam <br /> Co Lac aa`// <br /> APPLICAT&AiLINCI ADDRESS <br /> /Zy7o La+GK� .�. G /mss leo <br /> 9TW2T ADO�aL$ <br /> Z,,,CC Ze.'Xe CA 9SZ37 <br /> CITY 7sr coot <br /> PERSON TO BE CONTACTED REGARD[NO THIS APPLICATION <br /> NAVJ Tlsuc <br /> C1�y 7Z7- 9770 C7�i� 7�7- X773 �r�L�Go (. coeur <br /> PnOA NUMaeR YAX NVMeEa BLERAOMCMNL(bvAlll <br /> Et�EERROENCY CONT/AC/Y <br /> NAME <br /> CZ&4) 7Z7- S77o <br /> DAY ATONE NVNaEA NIaIR PXOrd NOvaaa CELWL" I-NOW 1`1 v 11a <br /> (Z,o 7z7- 5773 3 <br /> ���) <br /> e,.s:Numau PAaea NUHD[0. <br /> CERTIFICATION <br /> I underhand that iam legally rexponzible for the disposal of trucked non-hazardous waste and for complying with the Terms and <br /> Conditions of this Ducked Non-Hazardous Warta Disposal Permit(Parmit), and herrby carr that harardout waste as defined in <br /> Section 1SI 11 of the California Health and Safary Code shall ndtbe dupascd. (understand that disposal of trucked non-hazardous <br /> waste, as dacribed in this Permit it subject to EBhdUD Wastewater operation Division conditions. <br /> I certify undar penalty of law that this document and all nitachmenss were prepared under my direction or xuparvtsten in <br /> accordance wait a.system dasignad to assure that qualified personnel properly gather and evaluate the Information submitted. <br /> Bnscd on my Inquiry of the person orpersoru who manage the.ryetan, or those penans tlir ecdy Iwonzibia far gad.aing <br /> information,she Information submitted Is. to the best ofmy knuivledge and belief. true. accurate.and complete. lam aware that <br /> there are-slgnif Inns panaldes fur s ubmilting fo4a information, Including the possibility of fine and imprisonm ant far knowing <br /> violations. <br /> Nnuc TIstE <br /> 9 WNA DA*�Z <br /> (TOaGEIGMEOaY C"IM fxccui OR1CGt OR DVLY AUIMKIZED PcrvtSeNTAIivE. 511C9eNtIOnnON RMUIRZU' SOM sauce le) <br /> Rc.:se/il19/01 <br /> 700® '117 3:)HIIOS (LIM 1190 192 OTS XVd ZZ:TT q3A ZO/CO/LO <br />