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~~ ~/ <br />~___." :~ ~C_ <br />IcL,~,Sc PRINT OR T'~ _, except far reyuir2d siCnaturzs. Qut.~~tans? Cor~ta~ <br />~I~e DECI A.Sbestas <br />~' C~ntrc! 52~;;an, Z4ZJ S'~~ nth, Ste. 4~C, Fartland. QF 97Z~~, ~~a?} Z29~~58Z. OR Ca1~ 1-$~4-~~Z-~4~ 1 far <br />~...~~-_ <br />tre ~~cne numces aid 1CCatlon a~ your dacai reCi~nal GEC ace. <br />w~ S ~ G ~.~# E.~"+ i C r'~: (C.:,ntrs~ar - rz~~~ - C~es~tar~ . <br />~, ~s~estcs_rerrcvai site name and aCdr2ss: .~ ~ ~~~~ ~ j ~ ~ ~ c ~ ~r ~ ~ <br /> <br />~~ ~~~ ~~~`'~ `^ ~ ~ ~ _- <br />~ <br />~v 'tin <br />G~ h ~ <br />~~ 4 <br />51tae~ ~ ~, Ca.~- G:unty . Zp <br />r --._.~. nc~ne: ~ `! ~ ~ ~/~~G <br />Z. Cceratcr`s name any acdress: PROFESS IQNAL E~VIRCN~IENTAL ASS . F~tcne: 54I d88 6 <br />~ 4dZ <br />4I~C~WEST 1~TH <br />IPO A :. ~ f Eli'CE~~{E L~~VE ~ <br />~` CCFFIN BUTTE PALLS ~ <br />~ • .. ~ Y LA~VDFI~~L <br />~. ~las~e dts~.osa1 safe.. inc~ne: ~"~~ ~~ <br /> <br />~ 5 4 3 ~ 7 4.~ 714 4 ,. <br />28845 CCFFIN BUTTE Ra~D CCRV~LLIS B N <br />E. TON 9 7330 <br />s~~ <br /> <br />. Ces~.~~e asces.cs marenais: ~ ~. <br /> <br />~~~~ ~, <br />A <br />~~ S~~ ~ p ~ ~ /-~ ~~ .. <br />1 _1~~ ~~ <br />~~ ~ n <br />Vi ~~~~ `G r° ~~ <br />C~ncar'ners; fVumire~ ~ ~~ <br />.~.... . <br />. TcFa# Cuanti~f ~c~.;~ic ~ares~: u ~, ; ~ ,~ ~ . <br />T. 4PE~i~ i aR'5 CEO ~ rFiC~, i iC~~i: ~ t~efe~y declare ~ a= ~ e ccnrents cr his cc~s;5;;~;enr are ~,~il;~ and a~~ .~ratzfy <br />des~..~ced accve ~y ~rcoer s~~ic~ins ^ar~e and are :;assirie^, rac:ted, ,^~ar'{e^ arc ;aca:e~, are ara ~n ai1 res~.ecs <br />Ott Mrccer :M^c;iicn ~r dnsccr. ~~~ "rc"~~/ay acc :rCfn~ ;c ~cveritmerr r ~':,a"L~"S; 3i# ,~~cveme:~t cf asce5r:s- <br />CCn~a~i"irC~ ~^"are"ia) S~ al# Ore ~`~w14~' 4^ a'Nasre SSicrr;ent Rewcrd ~c ~~~. <br />PRCFESSI~N.~L ENVIRCN~fE~IT L <br />~ ~~ T ~ ~ ~R~ ~ C <br />~ are: .~~ .. C:~~~canv: ~..S4CI~TrS ±VC. <br />. . <br />~~~~c <br />~~C~,",a~4r ~~a~e: <br />~NSrCF~ c;~~S j: <br />~~"~RSLC~er ~ : (rzcxn~+eagment cf ; acaRo[ ci ,~~temafs~ <br />PE.~ IvC <br /> <br />~.ddress: 4~~ 0 WEST ~~ T~ =^cne: t~~ ~) 6 8 8 6 C 6 Z <br />~~rature: t--~- i ~ Cate: <br />~~ <br />~ 3 <br />. ~ ~~..~ <br />cans ~ ~ ~^~: ~~~~ ~t ~~ ~~c ~t rmc~ra,s~ <br />. ~ T--~ ~ <br />~ <br />~ ent: Ccmcany: <br />dress: U ~ ~ ~ / ~- ~ ~' _~ ~ ~~` ' v ~ nc~ne: J ~ - ` (~.. <br />Cnature: ~ Cate: ~ <br />~-~.5~-~ ~ <br /> ,, <br />SAL: (Cxt~~an at .~ ai ~~a m~tamts ~rr`MQ~vd by this m~ifext, ~t ~s ~ ~ +~.m ~ ~ ~w.~ <br />'ante Cis~asal Site: ~~' ~ ~~ ~ ~ ~ ~ <br />_~. <br />_. _.-___. 1. _ <br />erne and tide: <br />~natura; <br /> <br /> <br />Cara; ~ ~ ~ ~ <br />°hane: J ~ ~'~ Jr` ~ <br />5CrZ~?,4NCY S~aCS: ~,~d a~tm.na u ~..d.a~ <br /> <br />. J <br />