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Part 8.OPERATOR INFORMATION(For disposal site,if operator is different from land owner,attach lease or other agreement) <br /> TYPE OF BUSINESS: <br /> E]SOLEPROPRIETORSHIP PARTNERSHIP CORPORATION MGOVERNMENTAGENCY <br /> FACILITY OPERATOR(S) SSN OR TAX ID#: <br /> (Name): <br /> 4 <br /> ADDRESS,CITY,STATE,ZIP TELEPHONE M <br /> FAX#: <br /> E-MAIL ADDRESS: <br /> CONTACT PERSON(Print Name): <br /> ADDRESS WHERE LEGAL NOTICE MAY BE SERVED: <br /> Part 9.SIGNATURE BLOCK <br /> Owner: <br /> I certify under penalty of perjury that the information I provided for this application'and for any attachments is true and accurate to the best of my knowledge and belief. I <br /> am aware that the operator intends to operate a solid waste facility at the site specified above pursuant to this application and understand that 1 may be responsible for the <br /> site should the operator fail to meet applicable requirements <br /> 9— <br /> SIGNATURE(LAND OWNER OR AGENT): <br /> PRINTED NAME. <br /> TITLE: DATE: <br /> Operator: <br /> I certify under penalty of perjury that 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: 1 <br /> TITLE: DATE: <br /> Part 10.OTHER (Attach additional sheets to explain any responses that need clarification). <br /> Page 4 <br />