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d <br /> IIS <br /> Part 8.OPERATOR INFORMATION(For disposal site,if operator is different from land owner,attach lease or other agreement) <br /> TYPE OF BUSINESS: <br /> DSOLE PROPRIETORSHIP PARTNERSHIP ❑CORPORATION X❑GOVERNMENTAGENCY <br /> FACILITY OPERATOR(S) SSN OR TAX ID#: <br /> (Name): <br /> San Joaquin County Department of Public Works(Solid Waste Division) 6800-14563 <br /> ADDRESS,CITY,STATE,ZIP TELEPHONE#: <br /> 1810 E Hazelton Avenue,Stockton CA 95201 209-468-3066 <br /> FAX#: <br /> 209-468-3078 <br /> E-MAIL ADDRESS: <br /> tbahadori@sigov.org <br /> CONTACT PERSON(Print Name): <br /> Ta'Bahadori <br /> Part 9.SIGNATURE BLOCK <br /> Owner: <br /> 1 certify under penalty of perjury that the information 1 provided for this application and for any attachments is true and accurate to the best of my knowledge and belief. I <br /> am a e that the operator intends to operate a solid waste facility at the site specified above pursuant to this application and understand that I may be responsible for <br /> th) site sh Id t l et op rator faiapplicable requirements. <br /> I" <br /> SIGNATURE(LAND OWNER OR AGENT): <br /> PRINTED NAME: Desi Redo <br /> TITLE: Integrated Waste Manager DATE: l <br /> Operator: <br /> 1 certify under penalty of erjury t4at the information contained in this application and all attachments are true and accurate to the best of my knowledge and belief. <br /> SIGNATURE(FACILITY OPERATOR OR AGENT): <br /> PRINTED NAME: Desi Reno <br /> TITLE: Integrated Waste Manager DATE: <br /> Part 10.OTHER (Attach additional sheets to explain any responses that need clarification). <br /> Lovelace Permit Review 2015 Printed 2/23/2015 <br />