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Part 0. OPERATOR INFORMATION (For disposal site, if operator is different from landowner, attach lease or other agreement) <br />T YPE OF BUSINESS: <br />DSOLE PROPRIETORSHIP PARTNERSHIPCORPORATION F]GOVERNMENTAGENCY <br />FACILITY OPERATOR(S) <br />(Name): <br />30703 ADrive Tracy CA 95376 <br />ADDRESS WHERE LEGAL NOTICE MAY BE SERVED: <br />30703 <br />Part 9. SIGNATURE i1 <br />SSN OR TAX ID #: <br />#630293953 <br />TELEPHONE #: <br />(209)835-0601 <br />FAX #: <br />(209)835-7729 <br />E-MAIL ADDRESS: <br />Eker@tdswm.cf? <br />CONTACT PERSON (Print Name): <br />t�l1����'�� <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 />SIGNATURE (LAND OWN OR AGE <br />e <br />PRINTED NAME: <br />Ike Repett® <br />TITLE: Director DATE: <br />Operator: 4 <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 />PRINTED NAME: <br />Ike Repeit0 <br />TITLE: Director DATE: <br />Part 10. OTHER (Attach additional sheets to explain any responses that need clarification). <br />PaCO 4 <br />