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State of California California Integrated Waste CIWMB 675(New 10/02). ® Management Board 45-DAY OWNER OR OPERATOR TRANSFER NOTICE Owner Transfer: � Operator Transfer: a U (mark one or both) f [� ' fib'' Information Required on Notification for a Change of Owner or Operator at a Solid Waste Facility(PRC, Secti 4005) - 2 Q '1004 FACILITY/SITE INFORMATIONNViRO N sWls#: PER SRI LAO,, Facility Name: F X Address/Location: , Phone Number: (� OWNER/OPERATOR INFORMATION New Operator: R&LCANew Land Owner: jlryN, t Mailing Address: Mailing Address:li Phone Number: Log—,5+5- Phone Number: Date of Anticipated Transfer: f OPERATION INFORMATION (Complete if facility is a solid waste landfill) 1. Submitted Closure&Postclosure Mai enance Plan (C& PMP): Preliminary Q 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 Faciir nformation (RFI) Governing Qurrhent Design &Operation: Date Certification: I hereby certify under the penaity cf perjufy that the information provided is trOw and correct to the best of my;knowledge.and Belief. Furthermore,I hereby certify that l assuma inijrely,the fadlity'design and operations described in the current,R#I;.that . there will be no physical changes above;andbeyond,what isAtescnbed in the Rf 1,and that the facility will be operated in compliance with the terms and conditions of the approved perntt and=all othbrpplrcable requirements. Signature of Land Owner: Date: — r Signature of Operator: � ,�rw Date: Completion of this form is not required by regulation. It will provide the CIWMB and EA with the information required by PRC,Section 44005.