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* IF"YES", PLEASE ENCLOSE A COPY YES [:]NO <br /> IF"NO",WILL AN EIR BE PREPAF YES [—]NO <br /> WILL A NEGATIVE DECLARATION(ND)BE PREPARi=O? ®YES r-�NO <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 ®PARTNERSHIP x CORPORATION []GOVERNMENT AGENCY <br /> V.OPERATOR OWNER OF LAND ADDRESS:1333 E.Truner Rd Lodi.CA 95241 TELEPHONE#: ISSN OR TAX ID# <br /> INFORMATION (Name): USA Waste of California (209)369-6894 <br /> For land disposal, dba Central Valley Waste Services <br /> if operator is FACILITY OPERATOR ADDRESS: TELEPHONE#: SSN OR TAX ID#: <br /> different from (Name): <br /> land owner,attach <br /> lease or franchise ADDRESS WHERE LEGAL NOTICE MAY BE SERVED: <br /> agreement. <br /> I hereby acknowledge that I have read this application and the Report of Facility- Information,If applicable,JTID or ROWID 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. 1-1 <br /> SIGNATURE(LAND OWNER OR AGENT): N URE(FA 11-11>r`-0RATOR OR AGENT): <br /> TYPED NAME: TYPED NAME: <br /> Luana A.Pinasco <br /> TITLE: DATE: TITLE:Waste Management DATE: <br /> Administration and Contracts Manage 3/8/2002 <br /> VI.LIST OF ATTACHMENTS(CHECK IF APPLICABLE): <br /> ®REPORT OF FACILITY INFORMATION ®OPERATING LIABILITY FINANCIAL MECHANISM <br /> F-1 REPORT OF WASTE DISCHARGE PRELIMINARY CLOSURE/POSTCLOSURE MAINTENANCE PLAN <br /> ®JTD(RDSI/ROWD) ®FINAL CLOSURE/POSTCLOSURE MAINTENANCE PLAN <br /> ®CONTRACT AGREEMENTS FINANCIAL RESPONSIBILITY DOCUMENTATION <br /> DEPARTMENT OF HEALTH SERVICES PERMIT OTHER REGULATORY AGENCY PERMITS <br /> ❑LOCAL USE/PLANNING PERMITS x OTHER—Report of Station Information <br /> F-ICERTIFIED ENVIRONMENTAL REVIEW REPORTS(CEQA) <br /> INFORMATION 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 />