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IF"YES", PLEASE ENCLOSE OPY <br /> IF"NO",WILL AN EIR BE PED? YES 0 [:]NO <br /> WILL A NEGATIVE DECLARATION(ND)BE PREPARED? YES F-xjNO <br /> IF"YES",PLEASE ANSWER THE FOLLOWING: <br /> WHO WILL PREPARE THE ND? <br /> APPROXIMATE DATE OF COMPLETION: <br /> TYPE OF BUSINESS OPERATING FACILITY: <br /> SOLE PROPRIETORSHIP EDPARTNERSHIP CORPORATION GOVERNMENT AGENCY <br /> V.OPERATOR <br /> INFORMATION OWNER OF LAND ADDRESS: TELEPHONE#: SSN OR TAX ID# <br /> For land disposal if (Name):Forward Inc. 9999 S.Austin Road,Manteca,CA (209)982-4298 941544481 <br /> operator is different 95336 <br /> from <br /> land owner, <br /> attach lease or FACILITY OPERATOR ADDRESS: TELEPHONE#: SSN OR TAX ID#: <br /> franchise agreement. <br /> (Name):Forward Inc. 9999 S.Austin Road,Manteca,CA (209)982-4298 941544481 <br /> 95336 <br /> ADDRESS WHERE LEGAL NOTICE MAY BE SERVED: <br /> 9999 S.Austin Road,Manteca,CA 95336 <br /> 1 hereby acknowledge that I have read this application and the Report of Facility Information,if applicable,JTD or ROWD and certify that the <br /> information given is true and accurate to the best of my knowledge and belief. In operating the solid waste facility,I agree to comply with the <br /> conditions of the permit and with federal,state,and local enactment's. <br /> SIGNATURE(LAND OWNER AGENT): SIGNATUfRLE{F ITY OPERA OR AGENT): <br /> TYPE AME: D NAME: <br /> Kevin Basso Kevin Basso <br /> TITLE: DATE: TITLE: DATE: <br /> General Mana er January 27 2003 General Manager January 27 2003 <br /> VI.LIST OF ATTACHMENTS(CHECK IF APPLICABLE): <br /> REPORT OF FACILITY INFORMATION OPERATING LIABILITY FINANCIAL MECHANISM <br /> =REPORT OF WASTE DISCHARGE OPRELIMINARY CLOSURE/POSTCLOSURE MAINTENANCE PLAN <br /> JTD(ROSI/ROWD) FINAL CLOSURE/POSTCLOSURE MAINTENANCE PLAN <br /> =CONTRACT AGREEMENTS ❑x FINANCIAL RESPONSIBILITY DOCUMENTATION <br /> =DEPARTMENT OF HEALTH SERVICES PERMIT MOTHER REGULATORY AGENCY PERMITS <br /> =LOCAL USE/PLANNING PERMITS OTHER: <br /> =CERTIFIED ENVIRONMENTAL REVIEW REPORTS(CEQA) <br /> F7xINFORMATION ON THE STATUS OF THE APPLICANT'S COMPLIANCE WITH CEQA REQUIREMENTS REGARDING <br /> THE PROPOSED PROJECT. <br /> =EVIDENCE THAT THERE HAS BEEN COMPLIANCE WITH CEQA PRC,DIVISION 13,2100 et.sec <br /> version 4-6/96 <br />