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r.aa.u.aaruau PlwlgJ; jusLre—Ual Nameplate Corp EPA ID NUM3ERCAD981387749 <br /> G. FACILITY OWNER OR OPERATOR INFORMATION: <br /> Is the signer of this certification the: ❑ Owner or ® Operator? <br /> NAME: James Ellis <br /> ADDRESS: 110 E. Turner Road <br /> CITY: Lodi TT4TE, CA ZmCODE: 95240 <br /> TELEPHONE NUMBER: �) <br /> IL FINANCIAL ASSURANCE FOR CLOSURE: <br /> A. ESTIMATED CLOSURE COSTS: S (Please see instructions before entering my dollar amount) <br /> B. TYPE OF CLOSURE ASSURANCE MECHANISM: N/A <br /> C. MECHANISM IDENTIFICATION NUMBER(S): p <br /> (if applicable) <br /> D. FINANCIAL INSTITUTION, INSURANCE OR SURETY COMPANY, OR OTHER ORGANIZATION: <br /> NAME: N/A <br /> ADDRESS: <br /> CITY: STATE: ZIP CODE: <br /> E. EFFECTIVE DATE OF CLOSURE ASSURANCE MECHANISM: N/A <br /> F. ORIGINAL DOCUMENT(S) ATTACHED: <br /> © Attach the original document(s) used to satisfy the closure financial assurance requirements. <br /> © Attach the detailed closure cost estimate that resulted in the cost shown in item A (see attached model.) <br /> DTSC 1133 W96)Formerly 8113(1196) PAGE 2 OF 3 <br />