Laserfiche WebLink
>i i <br /> IV ENVIRONMEXW IMPACT REPORT(EIR) <br /> HAS AN EIR BEEN PREPARED FOR THIS PROJECT? x YES ®NO <br /> IF"YES", PLEASE ENCLOSE A COPY YES NO <br /> IF"NO",WILL AN EIR BE PREPARED? YES ❑NO <br /> WILL A NEGATIVE DECLARATION(ND)BE PREPARED? x YES �NO <br /> IF"YES",PLEASE ANSWER THE FOLLOWING: <br /> WHO WILL PREPARE THE ND? <br /> San Joaquin County <br /> APPROXIMATE DATE OF COMPLETION: Completed <br /> TYPE OF BUSINESS OPERATING FACILITY: <br /> ®SOLE PROPRIETORSHIP PARTNERSHIP x CORPORATION ❑GOVERNMENT AGENCY <br /> V.OPERATOR OWNER OF LAND ADDRESS: TELEPHONE M SSN OR TAX ID# <br /> INFORMATION (Name): 1145 West Charter Way (209)466-4482 /�d1 S <br /> For land disposal, Forward,Inc. Stockton,CA 92506 <br /> if operator is FACILITY OPERATOR ADDRESS: TELEPHONE#: SSN OR TAX ID M <br /> different from (Name): 1145 West Charter Way (209)466-4482 <br /> land owner,attach Forward,Inc. IStockton,CA 92506 <br /> lease or franchise ADDRESS WHERE LEGAL NOTICE MAY BE SERVED: <br /> agreement same as above <br /> I 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 ND OWNER OR AGENT): SIGN TU (FACILI PERATOR OR AGENT): <br /> TYPED NAME: TYPED NAME: <br /> Pete Keller Kevin Basso <br /> TITLE: DATE: TITLE: DATE: <br /> Environmental Manager March 2,1999 lGeneral Manager 2-Mar-99 <br /> VI.LIST OF ATTACHMENTS(CHECK IF APPLICABLE): <br /> ®REPORT OF FACILITY INFORMATION OPERATING LIABILITY FINANCIAL MECHANISM <br /> ❑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 El OTHER <br /> ®CERTIFIED ENVIRONMENTAL REVIEW REPORTS(CEQA) <br /> ®INFORMATION ON THE STATUS OF THE APPLICANTS 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 />