Laserfiche WebLink
IF"YES", PLEASE ENCLOOCOPY OYES NO <br /> IF*Na,,WILL AN EIR BE PREPARED? []YES [:]NO <br /> WILL A NEGATIVE DECLARATION(ND)BE PREPARED? 0YES ONO <br /> IF"YES",PLEASE ANSWER THE FOLLOWING: <br /> 0 WILL PREPARE THE ND? <br /> 1APPROXIMATE DATE OF COMPLETION: <br /> TYPE OF BUSINESS OPERATING FACILITY: <br /> (SOLE PROPRIETORSHIP ®PARTNERSHIP EICORPORATION 0GOVERNMENT AGENCY <br /> OPERATOR OWNER OF LAND DDRESS: -rssz r TELEPHONE#. SSNORTAX ID# <br /> :ORMATION (Nam): <br /> e land disposail, ir <br /> -parator is [FACILITY OPERATI�R ADDRESS: TELEPHONE P SSN OR TAX ID P <br /> Want from (NSM); �M- <br /> d owner,attach <br /> $a or franchise ADDRESS WHERE LEGAL mo-not-MA 7 BE SE975; <br /> 'esment <br /> ;reby Ona-wledge <br /> true <br /> =375app 10955 and the Repo il of Facility IfiT5-rm-2ffon,-T8p I bi JTD OrROWD and oertifyM211MG <br /> 3rmation given is tr 0 ra to the best of my knowledge and belief. In Operating 00 44�lip�, Aee'fftacdjlity,I agree to comply with the <br /> iditions of the perg with fodsral,State.and local enactment's. <br /> :NA (LAND SIGNATURE <br /> 'ED NAM ZICS 9,- AAAMO 7YPED7, LNnyl . <br /> DATE: -0 L4 TITLE: -L DATE: V�— <br /> I 1, <br /> L 01001�-nii,I I <br /> LIST OF ATTACHMENT3(CHECK IF APPLICABLE); <br /> [:]REPORT OF FACILITY INFORMATION OOPERATING LIABILITY FINANCIAL MECHANISM <br /> OREPORT OF WASTE DISCHARGE OPRELIMINARY CLOSURE[POSTCLOSURE MAINTENANCE PLAN <br /> []JTD(RDSVROWD) []FINAL CLOSUREIPOS17CLOSURE MAINTENANCE PLAN <br /> CDCONTRACT AGREEMENTS rIFINANCIAL RESPONSIBILITY DOCUMENTATION <br /> [:]DEPARTMENT OF HEALTH SERVICES PERMIT FIOTHER REGULATORY AGENCY PERMITS <br /> OLOCAL USE/PLANNING PERMITS tatnHER <br /> ®CERTIFIED ENVIRONMENTAL REVIEW REPORTS(CEQA) <br /> 11INFORMATION ON THE STATUS OF THE APPLICANTS COMPLIANCE WITH CEQA REQUIREMENTS REGARDING <br /> THE PROPOSED PROJECT. <br /> DEVIDENCE THAT THERE HAS BEEN COMPLIANCE WITH CEQA PRC,DIVISION 13.2100 etlec <br /> lesion 4-W96 <br /> O/ZO 39Vd NIiHVW 30E' BE#817860Z E9:6T 1700Z/60/90 <br /> 6 <br />