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SAN 10AQUIN <br />COUNTY <br />Environmental Health Department <br />AFFIDAVIT OF FACILITY CLOSURE <br />Facility Name: J � � � ��-�-0 ����� <br />Facility Address: 1 �D� .� �2b-��' eve �� S.{�,��.� � �}. qS 2�5 <br />Facility CERS ID: �O � �7 � O /.,� <br />Facility Closure Date: � ��91 �2S <br />Contact Info for the New Site Owner/Operator (If known): <br />JUL 21 2026 <br />ENVIRONMENT HEALTH <br />I, the undersigned, hereby affirm the following and attest that all the information is true and <br />correct: <br />1. I am the owner/operator or an authorized representative of the above-named facility <br />2. The facility ceased operations at the above location <br />3. All hazardous waste, hazardous materials, and any residual contamination were removed <br />from the site and transported off-site for proper disposal on �P�1� �� 1 -�Ii��C Y'eC.y��►h� <br />in compliance with all applicable local, state, and federal regulations. <br />4. All required closure activities have been completed, and final waste records and other <br />supporting evidence of site closure (site photos, etc.) are attached to this affidavit. <br />Signature: <br />Printed Name: ���fF' ����L�� %� � Y7� ��Z <br />Title: <br />Email and Phone Number: (, r''� �LI /e� <br />Date: <br />2//2/� <br />1 of 1 <br />���� ��®�j ��� � (� ���� <br />