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ENFORCEMENT AGENCY NOTIFICATION <br /> Operation Name: KQr ( .At"set\ i SpriS 1Vx(, <br /> Address/Location: <br /> Of 1 I-& <br /> _qs:10 4 -f42A <br /> Phone Number: (Z(x1 <br /> Operator: 140y S p.�&LAst 4 Land Owner: 4t r L �?. � ,���•� <br /> Mailing Address: Mailing Address: <br /> S",l q 3 w.Ot 16, 4W Ce 114 R ve. <br /> Phone Number. Phone Number: <br /> Operation Information: <br /> Authorizing Eligibility(Section of 14 CCR,Division 7,Chapter 3 or 3.1): <br /> Volume and Type of Waste/Material(s)Handled: f, fh G keti 1?)kr,U✓G (/�WYt* 6 nblL ya/C�� <br /> 3 t <br /> 4ycJ/Ylkr,uyLrfl, r�U�� 6kily <br /> Peak Loading: (dl:y -!,Z Cubic Yards or Tons' <br /> Annual Loading: 15-00 Cubic Yards or <br /> Hours of Operation: 713 knjk, —fi&ttiA 7aM1 Sam utwtbtr— flay h J Se&&DA L?nth <br /> 1 hereby certify under penalty of perjury that the information provided is true and accurate to the best of my knowledge and belief. <br /> Signature of Land Owner: l Date: 0 U <br /> Signature of Operator: / Date: <br /> Enforcement n A Name and Address: ON <br /> .::............::::::::.:::.::::.:::.:::::::;::....:......: <br /> Agency y <br /> ,F✓►v;ronmert��l LY <br /> tI& <br /> �illnQl <br /> ��fUtS <br /> Z <br /> logX. <br /> C <br /> Weber P <br /> VL. <br /> n <br /> C14 <br /> L�41 <br /> S 7� <br /> S� <br /> q 2c�Z Z <br /> £3 <br /> Completion of this form is not required by regulation,however,it will provide the enforcement agency with the information required by 14 CCR 18103.1. <br />