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tate dt'halifornia California Integrated Waste CIWMB 675(New 10/02) Management Board 45-DAY OWNER OR OPERATOR TRANSFER NOTICE Owner Transfer: ® Operator Transfer: ❑ (mark one or both) Information Required on Notification for a Change of Owner or Operator at a Solid Waste Facility(PRC, Section 44005) FACILITY/SITE INFORMATION Facility Name: Ka rd J' sett k Sons SWIS#: X Address/Location: 159 q ,L ' ?L, Phone Number: Y OWNER/OPERATOR INFORMATION New Operator:" ky ( CkC ff S New Land Owner: -am Mailing Address: Mailing Address: 1030 L dQ Phone Number: Phone Number: doq" D 5 Date of Anticipated Transfer: +Q OPERATION INFORMATION (Complete if facility is a solid waste landfill) 1. Submitted Closure& Postclosure Mai enance Plan (C&PMP): Preliminary ❑ Final El Approval Date for Revised C MP (per Title 27, CCR, Section 21890): 2. Approval Date of Amended F' ancial Assurances Demonstration: Financial Assurances er Title 27, CCR, Articles 1 &2): Operating Liability per Title 27, CCR, Article 3): Report of Facil' nformation (RFI) Governing C rent Design &Operation: Date Certification: I hereby certify under penalty of perjury that the information provided is true and correct to the best of my knowledge and belief. Furthermore,I'hereby_certify'that I assume entirely,the facility design and operations described in the current RFI;that there will be no physical changes'above and beyond what is described in the RFI;and that the facility will be operated in compliance with the terms and conditions of the approved,permit and all other applicable requirements. K Signature of Land Owner: Date: C) kSignature of Operator: { Date: 12-17-04 Completion of this form is not required by regulation. It will provide the CIWMB and EA with the information required by PRC,Section 44005.