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.1 1� <br /> Part 8,_©p RATOR 1I+�FOR�AATlO-N(For disposaisile.-if,operafor.is different from land owner;.atWh:lease or other agreemenl):.. <br /> TYPE OF BUSINESS:EI <br /> SOLE PROPRIETORSHIP ❑PARTNERSHIP ®CORPORATIOtd �GOVERRtMEidT AGENCY <br /> FACILITY OPERATOR(S) SSN OR TAX ID#: <br /> (Name): <br /> San Joaquin County 94-6000-531 <br /> ADDRESS,CITY,STATE,ZIP TELEPHONE M <br /> Department of Public Works (209) 468-3066 <br /> P. 0. Box 1810 FAXM <br /> Stockton, CA. 95201 <br /> (209) 468-3078 <br /> E-MAIL ADDRESS: <br /> borges@co.san-joaquin.ca.us <br /> CONTACT PERSON(Print Name): <br /> Annette Borges <br /> ADDREsswHERE LEGAL NOTICE MAY BE SERVED- <br /> 1810 E. Hazelton Ave. , Stockton, CA. 95205 <br /> Part 9.SIGNAT RE BLOCK <br /> Owner: <br /> 1 certify-under penalty of.FfflurYth4t,tha-information . vi Fthis�p�lis�ioae* .d <br /> er: . ash--t-i&true<.and _ ta-tt�l�si.flf,my-knowledW-a-ndtLsliaf._L <br /> am aware that the operator intends to operate a solid waste fiy at the sites above pursuant to this application and understand that I may be responsible for <br /> the site should the operator fail to meet applicable requirements. <br /> SIGNATURE(LAND OWNER OR AGENT] <br /> Annette Borges <br /> -PRINTEUNAME: <br /> Integrated Waste Manager <br /> TIT:6E: OZ7"�� <br /> Operator: &�V� <br /> I certify under penalty of perjury that the infomiation contained in this application and all nts are true and accurate to the bel/fmy knowledge and belief. <br /> SIGNATURE,(FACILITY OPERATOR OR AGENT): <br /> Annette Borges <br /> PR,4NTED.NAMF: <br /> Integrated Waste Manager <br /> TITLE: DATE: <br /> Part 10.OTHER (Attach additional sheets to explain any responses that need clarification). <br /> Page 4 <br />