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 for the waste classification listed above.

I hereby also acknowledge that, as required in 18 AAC 60.490 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 monofill;
• The type of waste that was disposed in the monofill;
• The geographical boundaries of the waste management areas; and
• Details of any final cover, cap, or other structures or devices installed as part of closure.