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AUTHORITY: Public Resources Code section 43600 et seq. <br /> PURPOSE, The information provided will be used to verify adequate financial assurance of solid waste <br /> disposal facilities listed, <br /> REQUIREMENT: Completion of this form Is mandatory. The consequence of not completing this form Is <br /> denial or revocation of a permit to operate a solid waste disposal facility. <br /> OTHER INFORMATION: After review of this document,you may be requested to provide additional <br /> Information regarding the acceptability of this mechanism. <br /> ACCESS: Information provided in this form may be provided to the U.S. Environmental Protection <br /> Agency,State Attorney General, Air Resources Board, California Department of Toxic Substances <br /> Control, Energy Resources Conservation and Development Commission,Water Resources Control <br /> Board, and California Regional Water Quality Control Boards. For more Information or access to your <br /> records,contact the Callfornla Integrated Waste Management Board,8800 Cal Center Drive, <br /> Sacramento,CA 96826. (916)255-2200, <br /> CA-SOLID WASTE-CPC(1/00) Page 3 <br /> CIWMB 106(4/96) <br />