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1 <br /> PArt 8.OPERATOR INFORMATION(For disposal site,if operator is different from landowner,attach lease or other agreement) <br /> TYPE OF BUSINESS: <br /> SOLE PROPRIETORSHIP PARTNERSHIP CORPORATION GOVERNMENT AGENCY <br /> FACILITY OPERATOR(S) SSN OR TAX ID#. <br /> (Name): <br /> A,4flDWS-C %0 k) -3 1— t aMs I�( <br /> ADDRESS,CITY,STATE,ZIP TELEPHONE#: RR QQ C� <br /> a0% �V� s3V 'fS <br /> a33 aU -f 'flooa ea FAX#'. <br /> �. N .. A 452 E-MAIL 3 <br /> dC t ` 1 ADDRESS: <br /> VVVV'"' YVd I. �oVtzc.vj Q S S Cows <br /> CONTACT PERSON(Print Name): <br /> ?,Vast Zcaln. <br /> ADDRESS WHERE LEGAL NOTICE MAY BE SERVED: <br /> C, o x ooa VIA 1.�Vn acv , CA, q s 3 <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 am <br /> aware thqttLe operator i ends to operate a solid waste facility at the site specified above pursuant to this application and understand that I may be responsible for the site <br /> show a rator fail meet applicable requirements. <br /> "4A <br /> SIGNATURE(LAND OWNER OR A ENT): <br /> KfJI�! .l�ll,Pi2/yrJ t <br /> PRI ME: <br /> :z /19 <br /> TITLE: DATE: <br /> Operator: <br /> I cerliff-u-64 penalty of rjury that the information contained in this application and all attachments are true and accurate to the best of my knowledge and belief. <br /> SIGNATURE(FA ILITY OPERATCWR AGEN <br /> , 6",!4hj vAZ4,1,, <br /> PRINTED NAME: Y <br /> f.41,f6jEe== 40-'L <br /> TITLE: LATE: <br /> Part 10.OTHER (Attach additional sheets to explain any responses that need clarification). <br /> Page 4 <br />