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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 />1-1 SOLE PROPRIETORSHIP PARTNERSHIP L&ORPORATION �GOVERNMENTAGENCY <br />FACILITY OPERATOR(S) SSN OR TAX ID #: <br />(Name): <br />C1 re LJ t'r+- rz-� <br />cl S33 J <br />Zol- 9iz - <br />FAX #: <br />1;I <br />Za1 - 9S2 - 185� <br />E-MAIL ADDRESS: <br />ACT PERSON (Print Name): II <br />ADDRESS WHERE LEGAL NOTICE MAY BE SERVED: T-(-tJn0' G.A <br />5 C.,%Y) J)J8rno. (.o , H&,rire st QOWeX Ca I'll -f0f0'.�., LL C� X 943 TI. G-alJtn S dl(J ci3�2z <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 I may be responsible for the <br />site should the operator fail to meet applicable requirements. <br />TITLE: iJ�/� 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 />7 <br />IL <br />PRINTED NAME: <br />TITLE: V UH f t: <br />Part 10. OTHER (Attach additional sheets to explain any responses that need clarification). <br />CONFIDENTIAL. <br />Page 4 <br />