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1 <br /> Environmental Information Form <br /> Part R <br /> llA'1'L•' ; <br /> (To be Completed By Applicant ) <br /> NOTE : In completing this form, use additional sheets if necessary . <br /> Answer all questions to the best of your ability . If a question <br /> ` is not applicable to your project, write NA (not applicable ) . <br /> Please do not leave blanks . Incomplete forms cannot be accepted . <br /> PERSON COMPLETING FORM PROPERTY OWNER xxxx AGENT OF OWNER <br /> Name Michael i. O'Neill, Njckel.�. Trucking Company <br /> Address 11923 Reqentview Avenue <br /> City_ Downey <br /> State'Zip California 90241 <br /> Phone (213) 861-132'1 <br /> A. PROJECT DESCRIPTION <br /> 1 . Type of application ! 0 Use Permit, D Major Subdivision, <br /> Zone Reclassification, [D Minor Subdivision, EJ Site Approval , <br /> Zone Variance , E] Other : <br /> 2 , Project location :_ 30131 so Highway 3'3, 'rroc-y, CA ---- <br /> Describe .the project; i .e . , request being ,nade and nature of use . <br /> Identify specific project components : Rcqu(_.- fur USe Fermit Yor truck <br /> service _ __J,a d1ivvi- relziy station. <br /> 21 ac M of existing parcels :­ <br /> Assessor <br /> 1 <br /> 3 . 'Total acreage of project: 5.21 <br /> Assessor Parcel # (s ) : 255 -020-12 and 255-020-27 <br /> 4 . If there is an existing EIR assessing any aspect of your project <br /> site: , provide title and date :1__.__.______� <br /> 5 . Other permits and approvals (County , Regional , State and Fedelal ) <br /> required for this project : <br /> AGENCY <br /> PERMIT __ <br />