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0 0 i <br /> IV ENVIROI4vIENTAL IMPACT REPORT(EIR) <br /> HAS AN EIR BEEN PREPARED FOR THIS PROJECT? OYES NO <br /> IF"YES", PLEASE ENCLOSE A COPY [:]YES [-]NO <br /> IF"NO",WILL AN EIR BE PREPARED? []YES [E]NO <br /> WILL A NEGATIVE DECLARATION(ND)BE PREPARED? [3YES NO <br /> IF"YES",PLEASE ANSWER THE FOLLOWING: <br /> WHO WILL PREPARE THE ND? <br /> APP --IATE DATE OF COMPLETION: <br /> TYPE OF BUSINESS OPERATING FACILITY: <br /> []SOLE PROPRIETORSHIP [:]PARTNERSHIP E]CORPORATION []GOVERNMENTAGENCY <br /> ------------ <br /> V.OPERATOR OWNER OF LAND ADDRESS: TELEPHONE#: SSN OR TAX ID# <br /> INFORMATION (Name): <br /> For lard disposal, -5hw&1A*p"x 2ZWF1-7avdFdLirA0(W7 C4-qZW 6V-6zI5UV1 <br /> if operator is FACILITY MINTOR ADMESS: TEPPORE 5: MN on TAX 10 9: <br /> different from (Name): <br /> lard owner,attach -1tzft//*pawx I 2ZWF1-7avdAUarA3fiV7 Cd-RVX -W-baw/ <br /> lease or Franchse 05TS9 WMRE LEGAL N=I PAT RE SERVED: <br /> agreemenk 2-RWFAkudAb1 Lh7&W C4 9M-V <br /> lhere bya 3W ge that I gave read ffil;application and ft44epott of Fact lity1fifo—rTnabon,lapp liMle,3T)or and ceWffiatihe <br /> information given is true and accurate to the best of my knovAedge and belief. In operating the solid waste facility,I agree to comply with the <br /> conditions of the p and with fede_r./sIMp/and local enact menfs. <br /> r WNE—R-OR SIGNATURE(FACILITY OPERATOR OR AGENT): <br /> ti <br /> TY 7z T7pff-NA <br /> T—TLE- DATE: <br /> 0 <br /> A.LIST OF ATTACHMENTS(CHECK IF APPLICABLE): <br /> ®REPORT OF FACILITY INFORMATION []OPERATING LIABILITY FINANCIAL MECHANISM <br /> []REPORT OF WASTE DISCHARGE []PRELIMINARY CLOSUREIPOSTCLOSURE MAINTENANCE PLAN <br /> []JTD(FIDSMOWD) E]FINAL CLOS TCL MAINTENANCE PLAN <br /> []CONTRACT AGREEMENTS [:]FINANCIAL RESPONSIBILITY DOCUMENTATION <br /> []DEPARTMENT OF HEALTH SERVICES PERMIT []OTHER REGULATORY AGENCY PERMITS <br /> 0 LOCAL USEIPLANNING PERMITS El OTHER AmwmWfft&At2F <br /> ®CERTIFIED ENVIRONMENTAL REVIEW REPORTS(CEQA) <br /> []INFORMATION ON THE STATUS OF THE APPLICANT'S COMPLIANCE WITH CEQA REQUIREMENTS REGARDING <br /> THE PROPOSED PROJECT. <br /> EIEVIDENCE THAT THERE HAS BEEN COMPLIANCE WITH CEQA PRC,MOON 13,2100 at.sw <br /> version 4-6% <br />