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Special Waste Proile <br />Page 3 <br />VI. Certiication <br />I hereby certify that to the best of my knowledge and belief, the information contained herein is a true, complete and accurate <br />description of the waste material being ofered for disposal and all known or suspected hazards have been disclosed. All Analytical <br />Results/Material Safety Data Sheets submitted are truthful and complete and are representative of the waste. <br />I further certify that by utilizing this proile, neither myself nor any other employee of the company will deliver for disposal or attempt <br />to deliver for disposal any waste which is classiied as toxic waste, hazardous waste or infectious waste, or any other waste material <br />this facility is prohibited from accepting by law. I shall immediately give written notice of any change or condition pertaining to the <br />waste not provided herein. Our company hereby agrees to fully indemnify this disposal facility against any damages resulting from this <br />certiication being inaccurate or untrue. <br />I understand that attaching an electronic signature, I am signing this document, consent to complete this transaction and receive all <br />related communication electronically, and agree this document will be binding as though I had physically signed it. A printout of this <br />document may be accepted with the same authority as the original. <br />If electronic signature is preferred, please submit completed (unsigned) form to your Special Waste Coordinator or Special Waste Sales <br />Executive to initiate signature process. <br />I further certify that the company has not altered the form or content of this proile sheet as provided by Republic Services. <br />Company Name <br />Date <br />Authorized Representative Name <br />(Printed) <br />Representative Signature <br />Title <br />(Printed) <br />April 2019 <br />Chelsea Bossenbroek Authorized Agent Stockton Delta Resort, LLC <br />October 5, 2020 <br />Stockton Delta Resort, LLC Burnt Wood