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7.Signature This form cannot be processed without a <br /> handwritten signature. <br /> GI)9 I 1-02 <br /> Signer's Handwritten Signature Date <br /> VAL•101 t_6i E L. .17)2ING?AL. LJC.N1.136t9- <br /> Name(print) Title <br /> 8.Signature of Permittee(Responsible Official) This form cannot be processed without a <br /> handwritten signature. <br /> I, Ui151e., f( 't \i\ (insert name of permittee or responsible official) acknowledge <br /> that the individual named above works at/for (11Am (4- 'Y'eirk (insert site/facility name) <br /> and is authorized to submit documents on the site's/facility's behalf. I understand that I may be <br /> contacted by Ecology to validate the account holder's employment at the site/facility name listed <br /> above. <br /> ?A 2b2� <br /> H i ten Signature Date <br /> C A(&\(1.vA [n nutti)6 <br /> Name(print) Title <br /> Note:You may skip this section if the responsible official has written, signed, and attached a delegation <br /> letter to this form or if the responsible official completes this form. <br /> To request an ADA accommodation, contact Ecology by phone at 360-407-6401 or email at <br /> ecyadacoordinator@ecy.wa.gov, or visit https://ecologv.wa.eov/accessibility. <br /> For Relay Service or TTY call 711 or 877-833-6341. <br /> *To expedite access, we are accepting scanned Electronic Signature Agreement Forms (ESAF). You <br /> are required to mail the original signed ESAF to Ecology for our official records. <br /> Office of the City Attorney A l 1 7149 <br /> A\,� <br /> APPROVED AS TO FORM <br /> David C.Hall,City Attorney Deputy City Clerk <br /> 10/2024 ECY070-743 Page 3 of 4 <br />