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i <br /> Part 6.OPERATOR INFORMATION(For disposal site,H operator is Werent Prom landowner.attach lease or other agreement) <br /> I <br /> I <br /> TYPE OF BUSINESS: <br /> 13SOLEMPRIETORSHIP 13PARTNFRSHIP x-1coRPORATION 0GOVERNMENTAIUNCY <br /> FACILITY OPERATORt$) MOR TAX ID d <br /> ;Name}: <br /> Fomaid, Inc. 941544481 <br /> ADDRESS.CITY.STATE ZIP TELEPWNE B <br /> 209.982.4298 <br /> VAX/ <br /> 209.982,1009 <br /> 9999 S.Austin Road, Manteca, CA 95336 LMAIL At sS' <br /> dtttChiiel r "en+CBs. o <br /> CN TACT PERSW iPnn1 Netre? <br /> Don Litch lend <br /> ADDRESS WHERI'E.L(M NOTICE MAY W SERVED <br /> 9999 8 Austin Road. Manteca,CA 95336 <br /> Part 9.SIGNATURE BLOCK <br /> Owner: ' <br /> t certify under penally or perjury that the Information I provided for this application and for any afthmonts is true and accurate to the beet of my knowtadge and belle!. I am <br /> aware that"operetot Intends to operate a solid wasta facility at the site specified above pursuant to this application and understand that 1 my be responsible for the elle <br /> should the operator fail to meet applicable requirements. <br /> SIGNATURE RAND OWNER OR AGS <br /> I <br /> PRINTED NAME-DON LITCW,SLD <br /> I <br /> TITLE ENVIRONMENTAL MANAGER DATE, <br /> operator: / 7 <br /> I certify under penaky of perjury hurt the Informetion contatnod In this application and all attachments are true and wowate to the best of my knewledya and belief. <br /> SIGNATURE!FACILITY OPERATOR OR AGENTI. j <br /> I <br /> PRINTED NAME DON UTCMFIELD <br /> /z.zJ—z <br /> 1 <br /> TITLE ENVIRONMENTAL MANAGER DATE i <br /> I <br /> Part 10.OT"ER (Attach additionsl sheets to explaln any responses that need ctadfloation). <br /> I <br /> i <br /> Page 4 <br />