APPENDIX: CERTIFICATE OF OPERATION

Date:                                                                                                                 

Name of Property Owner or Operator:                                                            

Address and Telephone Number:                                                                     

Type of Operation:

Salvage Yard          Junkyard          Automobile Graveyard       

Type of Business:

Sole Proprietor          Partnership         Corporation         Other (Specify)       

State Sales Tax No.:                                                                                     

Brief Description of Operation:                                                                   

Location:                                                                                                        

Physical Boundaries of Operation: Attach a plot or drawing with physical dimensions designated.

Method of Screening:

Fence        Planting        Natural Objects          Other Appropriate Objects       

"I Certify that the above described establishment or expansion is in compliance with the provisions of Chapter 110 of the code of ordinances for the county and the rules and regulations governing screening of salvage yards, junkyards and automobile graveyards. This certificate does not imply approval or permission to acquire, handle, store, dispose of or deal in toxic or hazardous wastes."

Sebastian County Judge or Representative:                                                   

Certification Denied:                                                                                        
Denied; Pending Further Action: