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4 <br /> S.OPERATOR INFORMATION(For disposal site,if operator is different from lard o:.-,er,attach lease or other agreement) <br /> a GOVERNMENT AGENCY <br /> TYPE OF BUSINESS: ❑PARTNERSHIP �CORPORAT;ON k <br /> SOLE PROPRIETORSHIP SSN OR TAX ID K <br /> FACILITY OPERATOR(S) <br /> (Name): 94-6000-531 <br /> San Joaquin bounty TELEPHONE#: <br /> ADDRESS.CITY.STATE.ZIP (209) 468-3066 <br /> Department of Public Works FAX#: <br /> P. 0. Box 1810 (209) 468-3078 <br /> Stockton, CA. 95201 E-MAIL ADDRESS: <br /> aborges@cO.san-joacuin.ca.us <br /> CONTACT PERSON(Print Name): <br /> Annette Borges <br /> ADDRESS W^'ERE LEGAL NOT,CE+:1AY 3E SERVED <br /> 1810 E. Hazelton Ave. , Stockton, CA. 95205 <br /> Part 9.SIGNATURE BLOCK / <br /> knowledge and belief- i <br /> Owner. Plication an for an tta rTents is true and accura eta the best of my <br /> er ur that the information I ovided�rihis app ed above pursuant to this application and understand that I may be responsible for <br /> I certify urcar penalty or p 1 i f�' <br /> am aware that the operator intends to operate a S,rlequaementsli at the site sp <br /> 0 the site should the operator fail to meet app <br /> SIGNATURE '_AND O,+';ER OR AGE`1T). <br /> Annette Bor es <br /> PRINTED',- <br /> inte rated Waste Manager r DATE <br /> Ti rLE <br /> is /. C ��- / <br /> Operator: - f m knowledge and belief. <br /> I certify <br /> urder penalty of perjury that the information contained in this application and all attachments are true and accurate to the be Y <br /> SIGNATU^= FA&L TY OPERATOR OR AGENT). <br /> Annette Borges <br /> pk'N!ED'-,IC, _ <br /> Inter <br /> ,iced (,'ante i,tanager DA,E: <br /> TI1 LF' <br /> Part 10.OTHER (Attach additional sheets to explain any <br /> responses that need clarification). <br /> Page 4 <br />