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r: <br /> Name of Affiliate Name of County Relationship <br /> or Entity Commissioner or employee <br /> 1 . <br /> 2. <br /> 3 . <br /> 4 . <br /> 5 . <br /> 6 <br /> 7 . <br /> 8 . <br /> ( gnature) <br /> y <br /> (date) <br /> STATE OF -' L <br /> COUNTY OF Snd an ul P 12 — <br /> Personally appeared before me , the undersigned authority, �►� t5 <br /> who after first beings om by me , affixed his/her signature in the space provi ed above on this <br /> � V day c , 20 0q4 <br /> 'Y� A <br /> q4 <br /> v*' 01"' Tammy A hlowrd <br /> Notary Public, at large • -My C.wwUWm OD04W <br /> My Commission Expires : Oyu aoo� �%at/ E • AWL* JZ =0 <br /> t <br /> * * END OF SECTION <br /> 00452 - Disclosure of Reladonshlps.doc <br /> 00452 - 2 <br /> F1UBIItles%UTILITY - ENGINEERINGIWTP • North ROW RO Brine Line Discharge - UCP#=0WZ1D DOCUMENTS North County ROWO DOCUMENTSW0452 • Disclosure of <br /> Relstlonships.doc Rev. 05/01 <br />