ADEC Solid Waste regulations require that the landowner consent to the property being used as a landfill with the conditions below. This form is to be completed and signed by the legal owner.

I hereby acknowledge I am the owner of the above described property and give my consent for the property to be used as a Class III Municipal Solid Waste Landfill.

I hereby also acknowledge that, as required in 18 AAC 60.396(b), upon closure of the above landfill I agree to the placement of a notation of the property deed as permanent notice that:

• The property was used as a Class III Municipal Solid Waste Landfill;
• The property may not be suitable for some uses;
• Maintenance and repairs to the property might become necessary to prevent pollution problems at the site; and
• Any activity that results in damage to the final cover of the property must be corrected to control potential pollution problems.