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FACILITY NAME: Ltj I C�'iA*')lcS L„�G DNo.: '000�y6 /8L <br /> (See instructions on reverse) <br /> IX. FACILITY JOPERATOR !NAME <br /> X. FACILITY OPERATOR ADDRESS <br /> fnM DI YI Y1CI r'ct 7/5Aa1^) ii,c.4" I(/(Zd r, <br /> /ILr� I//[�I I I I 1 I <br /> IOro1 biu1 SII IRI rIAi-j I/AAA, AA, I16 I I I <br /> {Iy <br /> ff (Address) <br /> AAA-iGA1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 A ,q,s33,61 - I I I I <br /> (city) (slate) (ZIP Cody <br /> XI. FACILITY OPERATOR TELEPHONE NUMBER <br /> 09 - Z31 - �1 <br /> (Area Code and Number) <br /> XII. DESCRIPTION OF SPECIFIC WASTE TYPE(S) TREATED (Use only the space provided) <br /> [ crr�uS 4�/�s�`.JA�ia�S <br /> o;= LnJ 414 A.ja coN�1�a,�y <br /> XIII. DESCRIPTION OF TREATMENT PROCESS(ES) USED (Use only the space provided) <br /> pill ALSu LTiv—. , n1e --*A(-r-6*77:. _ )'Leech }- <br /> ��/1�1,1 ? /-1r.r0 �/��•.� <br /> XIV. OPERATOR CERTIFICATION <br /> It is my Intention to operate the above facility under Permit-By-Rule for Fixed Treatment Units <br /> pursuant to Title 22, California Code of Regulations, Section 67450.2(b). <br /> I certify under penalty of law that this document was prepared under my direction or supervision in <br /> accordance with a system designed to assure that qualified personnel properly gather and <br /> evaluate the information submitted. Based on my inquiry of the person or persons who manage <br /> the system, or those directly responsible for gathering the Information, the information is, to the <br /> best of my knowledge and belief, true, accurate, and complete. I am aware that there are <br /> significant penalties for submitting false information, Including the possibility of fines and <br /> Imprisonment for knowing violations, <br /> t� rJ oa rS t'IQeS10e.�' 1 Y <tPu-�•.a.�s <br /> k JJ-7�J <br /> nota,. 1 Vote igned <br /> Distribution: DISC—White and Yellow; Nofifler—Pink and lnskuetlons <br /> DISC 8462(11191) -')y's Page 2 of 2 <br />