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IV ENVlRO*,,IENTAL IMPACT REPORT(EIR) <br /> HAS AN EIR BEEN PREPARED FOR THIS PROJECT? []YES ®NO <br /> IF YES", PLEASE ENCLOSE A COPY []YES NO <br /> IF"NO",WILL AN EIR 13E PREPARED? [:]YES NO <br /> WILL A NEGATIVE DECLARATION(ND)BE PREPARED? []YES E]ND <br /> IF"YES",PLEASE ANSWER THE FOLLOWING: <br /> WHO WILL PREPARE THE ND? <br /> 1APPROXIMATE DATE OF COMPLETION: <br /> TYPE OF BUSINESS OPERATING FACILITY: <br /> ®SOLE PROPRIETORSHIP []PARTNERSHIP E]CORPORATION [:]GOVERNMENT AGENCY <br /> V.OPERATOR OWNER OF LAND ADDRESS: TELEPHONE SSN OR TAX ID <br /> INFORMATION (Name): <br /> For land disposal, -%zft/ F/-7a#d/7d/-if7D1V7 C4-qPX 1,Wb177-WgW M-&2w/ <br /> if operator is FAGILITY 6E 57 ADDRESS: LE #:ff: 99N-OR TAX ID <br /> different from (Name): <br /> lard owner,attach -%v&s11*pwmr 2ZWE1-7mdRYLitx--b7 Ca-qVX' -W-&ZI5W/ <br /> lease or franchise -ADDHESS WHERE LEhAL NOTICE MAY BE SERVED: <br /> agreernent. 2&W EjcbW Rd L#vb7 C4-WX <br /> I hereby acknowl®ige at I have read this appkationand the Report of FaWfly—Inorm ation,0 appliElTe—,JT)or OW and that Fhe <br /> information given is true and amurate 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 apd with feder4,stile,and local enactments. <br /> SIGNATURE(L 0 R D AGE S1SN--ATUFE-(FA-d[J-TY OPERATOR-ffR-MENT): <br /> 2. <br /> TYPED NAME: TYPEDNAME7 <br /> Aaron Leach <br /> 71—TET--, Manager DATE: -oa TITLE:.. ....... DATE: <br /> Plant <br /> VI.LIST OF ATTACHMENTS(CHECK IF APPLICABLE): <br /> ®REPORT OF FACILITY INFORMATION [:]OPERATING LIABILITY FINANCIAL MECHANISM <br /> []REPORT OF WASTE DISCHARGE ®PRELIMINARY CLOSLFEIPOSTCLOSURE MAINTENANCE PLAN <br /> []JTD(RDSIIROWD) E]FINAL CLOSUREIPOSTCLOSURE MAINTENANCE PLAN <br /> []CONTRACT AGREEMENTS [:]FINANCIAL RESPONSIBILITY DOCUMENTATION <br /> ®DEPARTMENT OF HEALTH SERVICES PERMIT E]OTHER REGULATORY AGENCY PERMITS <br /> ®LOCAL USEIPLANNING PERMITS El OTHER <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 /> ®EVIDENCE THAT THERE HAS BEEN COMPLIANCE WITH CEGA PRC,DIVISION 13,2100 et.sec <br /> version 4-6196 <br />