HomeMy WebLinkAboutEnvironmental Assessment EAX1994016 - Signed ApplicationJ 1
40
HUNTINGTON BEACH
City of Huntington Beach
Department of Community Development
2000 Main Stree`
Huntington Beach, CA 92648
(714) 536-5271
G NERA T APPLICA TION:
PL:inning Commission
oning Adininist. ator
Staff Review
Design Review
Sandy Ryan
Applicant or Authorized Agent
1614 S. }larbor Boulevard
Mailing Address
Fullerton, CA 92632
City state
714-449-1000, tengjg-n
Telephone Number
Leedy Ying
Property Owner
1614 S. Harbor 13oule
Mailing Address
FuIIErt-on, OX 92632
Zip
FOR OFFICIAL USE ONLY
Present Zone
General Plan Designation
EN'r"TLEMEN'T $FEE CASE 9
Administrative RcxiC%K-AR
Code Amendment CA
Cond. Exception (Variance) CE
Conditional Use Permit CUP
General Plan Amendatent CPA -_ ._
1,imited Sign Pcwtnit I SI'
Planned Sign Pro r m PSP
Prec. I Ian. Strect Al ;rt Pl?$i
Prel minaryFlan I?e die y„ PPR
Site Plan Amendment
SSTCitalsign Prnl<
Use Permit
Zone Chanr;
Other
CNIi. 5:_
l:nvironnrenial
Exempt
See. Class
ssesnient lle(l
C-)astal Area Yes
t ;ategorical F.xcltssiot
1"x;:ntl*t
Flood Zone
Alquist Priolo Area
Oil District
Methane listrtct
Rctle 'elopant:att Area
to p " `c iti .ttmcn
l:)at¢; Rec
City State Zip
714--447--11J00, Extension 124
Telephone Number
R QUEST IJse additions] n !e if nceessan _one l 1311(le
from (Q) C-4 to C-4 for 8032 -0,7arner ivvr,nuo,
Parcel #167--324-14, Lots 19 & 21 of Tract
298, City of Huntington Beach, County of
Orange , State of California
Existing Use: Ee,L hm
.h,riicant Authorization
" P1dm
Notihcaton Req.
?c Narrative
otograp?is
Concurrent Cases:
Previous Cases:
Entertain. vent Perin it
Map Book Log i'ui saint to I II30C Sec:...,..
l'Ian Bate Stamped
__Computer Log lit Lieu ofl 3t )C See-,____
LOCATION AND DESCRIPTION OF PROPERTY:
Street Address:8032 Warne'-Ave i:ac', I Iuni.. i-nd jt :.r on i B_,acb
Assessor's Parcel Number:167-324-14
A Tract:298 _ _Block'
cre,ig;e
Lot
Leedy Ying ._.._(Prrjj+wy. (harts), ]i,c retsi tnc: titt9 rstrxi_sa t;U aisLttis including th- filing
requirements on the reverse side o1 misapplication. I aril the property owner ml the k,`ah c 't }r ='l'titc- 1 iwrcta affirm under
penalty of petjmy Mat she foregoing statements. facts and attachments are true and correct. I understand that This app ication
tll,j sue lrc nciaion or raatclilica;ion Iiatastfor entitlement or,,ariance may be denied, modified of approved with conditions an(-s i irw tr,.atabe complied with prior to issuance of building permits I hcrt)n amhQIir r- _ 'r?tf - to ;tct
as my representative andjto bind me in , dl natters concerning this applic.attots.
Signature of
[1A"A LA4 .,[11 AV.v A1,'t,j i, (1 t.tYA A4iY
1. This application must be typed or printc.i and li;led in w.:nmpletc.ly.
2, If the applicant is not the propei,,i Own,"r, the property ',nu uer shall designate the applicant to act cn his ochaif and both shall
sign this application,
3, All applications for Planning Commission must be accompanied with six (0) preliminary site plans, floor plans and building
elevations a maximum of 24" X 36" in size. Upon acceptance and scheduling of hearing date, two (2) sets of plans reduced to
8-112" X 1I" and one (1) set of plans colored to illustrate the design and development concept of the projectsha'l be
submitted. Other plans mayhe required depending on the complexity of the project,
4. All applications for the Zoning Administrator must be accompanied with six (6) se's of site plans, floor plans and building
elevations a maximum of 24" X 36" in sire, and one (1) set of plans reduced to 8-1/2" X I I". Other plans may be required
depending on the complexity of the project.
5. All applications fort, taff review or design review must be accompanied with six ",:ai ,ets of ate plank, floor plans and bu`flding
elevations 24" X 36". A matr is palette and colored rendcrraa are required for dcsilx: review only,
6. 4d, plans shall conform to the lbllouwing requirements:
(a) Draw to scale; indicate scale; indicate dimensions of building and floor arses: and north direction ,arrow When feasible.
plans shall he oriented so that aorit, is at the top of the page.
(b) Plot the entire parcel and dimension all pertinent data such as casements, dr.e ra,vs, landscaping, parking, and distances
to all property lines.
(c) Plot all existing and proposed physical feature,; and structures on the yaih?cct lsacgatert,, and abutting, properties.
(d) Dimension to the nearest intersecting street artd dentif% all srreLi aatnes
(e) Include a legend (locate in lower right corner of the site plars) winch lists the muane, ;addr s , and phone number of the
recorded owner and the applicant.
(1) Identify the legal description of the subject property on the site plan"
(g) Label uses of each room on floor plan.
7. Fold all plans to a maximum size of t-1 /2" X 14" -,iwvr rig tprint
8. A signed statement declaring whether the protect site is or,is not lau;rted a itgtrrr :t i l.a, r t9t,.ca V%. ste and Substance site
pursuant to Section 6591%"12` .5 of the Government :ode
9. Public notification requirement;, for Conditional I xt vntro r i v',ari zit: t, t"oaditinua:l t se Permit, (Use 1'erwit. /one C'haart,ge.
Precise Plan Sfrcct Alignment General Man Amendment, Special n'.u Permit °t '4 t.iartitckd Sarni Permit ; Sau art n;,hed
sheet).
10. Photographs of the subject property.
11, Environxnen,.-1 Assesstncin
12. A massing model will be required for all comrrtcrcial development aatd alt resaucntial developments of ten (10) units or more
(throe [3] units or more in redcvelopnr,:nt prt?ject areas).
13. A written narrative of the proposed use or project shall accompany this application The uarrative shall contain the following
information:
(a) Cite reasons for initiating this application.
(b) Area description and population served by the proposed use of project
(c) Description of project and ,services, including square footage. hours and days of operation. number of employees, anal
other infor..nation as apparopriate.
(d) Descrintion of surrounding use &o the north, south, cast aanu •„est
14. In order to support findirgs for approval for Conditional Exception ( `Cariance), Lunited Sign Perunit, or Special Sign Permit
answer the following questions.
(a) What exceptional citcuinstane:cs apply to petitioned propert- (iaacludinf, we, shape. topol;raphy. location or
surroundings) that deprive it of'privileges aoranally enjoyear
(b) Explain why the request will not constitute n grant of special prig ilege irtceaasistent with normal limitations.
(c) Why is this request necessary for the prese:vatloll and enjoyment of one or more substantial property ris lrts`r
(d) State reasons why the gran vg of this request will not be rnutterially° detronentai to the public w -ellhre
15. ?Freq-.aired by the Police Departnment, are entertainment permit shas% a .riatpars tlrss aaltlalz,at:,tit
16. Supplemental application submittal requirements (see att;iel d Sit
17. All Planning Commission and Zoning Administrator &.ision; are finial uurle.s i3ppe algid aw°ith:n teal ( 10) days of such decisiorn
The appeal shall be in writing spccifying the aatci s of aggrie- cttaeot, In no case shall lbuailding permits, c rtrfaca_tec of
occupancy, or licenses be issued until the appt':d period ha, elapsed
18. All applications shall become null and -,old if'the aappro% e:d use of proa ,-.zt hati not b,, ai initiated withint one ,I) year from the
approval date.
NOTE: Completion of the application does not presume approval Of tlaa ip alieartie a. uch ;ipprta ral is discretionary
Zoning Administrator or the Planning Coromis,,ion_ The Zoning Adnimistratur or Plaaiuaual^ Commission may deny,
conditionally approve the application,
h:'.anrppln,
CITY OF HUNT INGTON BEACH
APPLICATION PROCESSING CHECKLIST
ENTITLEMENT NO,^PLANNER
APPLICANT -ADDRESS
REVIEW FILE FOR COMPLETENESS:
Entitlement Logged in (Book rnd Map)
APPLICATION:
Request Complete (Special Per,nits/Variances)
owner's Signature/Letter of Authorization
Legal Description/AP loo./AP Map
Verify Zoning/General Plan
Narrative
Photographs
Additional Fees Paid
Address C:rrect
Pr kNS
Proper Number
Complete and internally consistent Sets 'Site 1`>lr3n,
Elevations, Floor Plans, Section.; Drawings)
Accurate (Property Lines, Street Names, xistin g aad
Proposed Buildings, Fully Dimens4.oned, Ea cements, Drawn to
Scale, North Arrow, Adjacent Improvements 'uses, Floor
Plan, Street Width)
Applicant's Name, Address, Telephone Number
Ownership List Accuracy: Verified Most Cur ent
(Map and Mailing Labels of Owners and/or Tenants,
Applicant, Site Property Owner, Agent and Matrix)
PRELIMINARY PLAN CHECK (See Plan Check Sheet)
OTHER ISSUES;
_ Flood Plain _,.E sem nt,s
FAA Specific Plan
Alquist-Priolo/Sei sini.c oil Wells
Hazardous Waste Site ,.Adjacent E
Previou s Entit leme nts and Condit ion
and Conditions
STAFF MEETING (Project Review)
DEVELOPMENT REVIEW REQUEST SENT (Tract Maps ASAP):
(See Entitlement Re-View Request List Memo)
ENVIRONMENTAL REVIEW (_ _ Cat . Exemp. , .._,__.,_Neg . Dec. _,_EIR)
Check Mitigation Measures of 'reviously approved EIR/N.D.
COASTAL STATUS (_Exempt, __Cat. Excluded, ,.-_,_,T CDP)
CONCURRENT PROCESSING (Other. Entitlements/Fees)
FIELD INSPECTION:
Adjacent Uses Parking/Driveway Existing Use(s)
Illegal Structures Landscaping Condition
Non-Conforming Signs -_Trees
SEND FILING STAi-US TO APPLICANT
SUBDIVISION MEETING REQUIRED
Notices Sent
DESIGN REVIEW MEETING REQUIRED (Materials & Color Board)
LEGAL SERVICES REQUEST SENT (Ordinance, Opinion, Code Amend.)
ENVIRONMENTAL ASSESSMENT COMMITTEE
Send Legal Notices with labels)
PREPARE STAFF REPORT
Prepare Attachments
Revised Plans
Reduced Size Plans
PLANNING COMMISSION MEETING
Colored Site Plans , Floor Plans and Elevations
Massing Model
Prepare Categorical Exclusion letter for Coastal.
Notice of CEQA Categorical Exemption (Collect Processing
(1658D)
(2/4/94)
City of each
2000 MAIN STREET CALIFORNIA92648
DEPARTMENT OF COMMUNITY DEVELOPMENT
Building 536-5241
Planning 536,5271
October 17, 199.1
Sandy Ryan
1614 S. Harbor Boulevard
Fullertcti,, CA 92632
ENTITLEMENT S ZONE CHANGE NO 94-6
PROJF,CT ADDRESS: 80x2 WARNER AVENUE
PROPER TY OWNER: LEEDY YING
DATE REC*c"1VED AT ZONING COUNTER: OCTOBER 5, 1994
PRO ECCT PLANNER:WMMNE CARVALRO
Dear Applicant:
REWWSED LETTER
Thank you for submitting your en:;tlernent(s) to the City of Huntington Beach, Community
Development Department. The Prc'ect Planner indicated above is assigned to processing your
entitlement(s). The Project Planner is responsible for,
*Reviewing your entitlemem(s) for completeness,
0 Reviewing , tans for compliance with the Zoning Code and applicable City Ordinances;
•Evaluating the project for conformance with the General Plan;
0 Preparation of environmental documents pursuant to the California Ergvironmental Quality
Act (CEQA);
0 Obtaining other city department's comments relative to the project.
0 Analyzing the site plan layout and, if applicable, the floor plans and elevations;
!Evaluating the project for compatibilhy with, and potential impacts to, surroundi ,
uses/structures,
s Coordinating issues related to the Fire Dept., Public Work s Dept., Building Division, etc.;
®Scheduling the project for a public hearing;
® Preparirig a recorrrmendation(approval/denial) with findings and conditions; an (
Assisting your with any follow-up actions andior conditions of approval.
A letter will be sent to you regarding the status/completeness of }y,ur entitlement(s), or Your
pending hearing date, within four to six weeks, A longer period may be required depending upon
the length of response time necessary by othc, departments. The letter will indicate either
additional information is required (e.g., revised plans, supplemental plans, environmental
information, additional entitlements, etc.), or that your project is ready to be scheduled for a
Zoning Administrator or Plannin? Commission hearing.
If the project is subject to PlarL-ing Commission review, a ,•taf report will be prepared with your
maps and supplemental information attached; no written reports are prepared for Zoning
Administrator action.
Generally, the total processing time (from submittal to final action by the reviewing body and
expiration of the appeal period) averages two months for Zoning Administrator action and four
months for Planning Commission action, depending upon the complexity of your project. When
Zone Changes, General Plan Amendments, or Tentative Maps are involved, a longer processing
time is necessary.
Please dii ect all of your questions and communications to the Project Planner using the
entitlement number(s) assigned to your case. You should contact the Project Planner at
714/536-5271 to discuss any concerns you may have regarding your project. Should you have
any comments or need additional clarification; please contact inc at the same number.
Thank you.
Scott Hess, A YCP
Senior Planner
Current Planning Se,
cc. Property Owner
Project Planner
(g:entltr/ssO01)
PLANNING DIVISION t
INSTRUCTIONS FOR COMPLETING
ENVIRONMENTAL ASSESSMENT FORM
S BMITTAL NFGRMA`'T'ION:
If a project is subject to the requiremenr,; of tl,e. California Environmental Quality Act (CEQL' )
and is not exempted un,cr any of the provisions of the CEQA Guidelines, the City must conduct
an initial study to determine if the project ml-.y have a significant adverse effect on the
environment, or whether previous environmental analysis has been performed which adequately
addresses the imp,;..'s of the specific p;;)ject being proposed.
The attached Environmental Assessment Form is to be filed with all such projects, and must be
accompanied by the applicable processing fee and a iegal description of the property. If the
Environmental Assessment Committee determines that an Environmental Impact Report (EIR)
is required, an additional fee will also ire required for reimbursement of costs 'ncurred in the
processing of the EIR. Additional fees fOr mitigation monitoring may be required for approved
proj"ts prior to project implementation.
Please print or type all responses. I additional sheets if necessary. If'the information
reouested does not apply to the project, insert "NA" (Not Applicable) in the space provided.
Please contact the Planning Division at (714) 3b-5271 if you have any questions regarding ta.e
Environmental Assessment Form.
PROCE?SING PRO C'Eafl'RL -
When the Planning Division receive; this, form. it wilt use the information t;= conduc€ an Initial
Study of your project. Following i!at": rde g.pa tpnent.rl review of the projr:ct lay. staff. the Initial
Study will be completed. The I.`nr iatm! °ratr:a? ; , e ,,stncz t Committee Xv-ill then determine
whether a Negative Declar:oha should i e pcpurr.rrcrtded or an I=M required. 11"w EIR is
required, the Environmental sses:"meant ` lalrutnee a il: determine the scope ofthe EIR. The
Planning Division will transmit a l:tter o %ou dese:ribing the procedure to be followed and the
specific areas of concern to be addressed in the 1 l'k.
PUBIL C IIEARING:
If a Negative Declaration is required, the d;s cr; enteati.;a must be prepared and advertised ror
public review for at least .-)l days prior 10,111" action heing4 taken on the aeeonipany_ng
entitlement.
If an EIR is required, the report 171aist l I prepared, advertised and circulated for public review,
and any comments received must he repurded to before the project can be scheduled for public
hearing, Additional public input on the LM may be provided during the public hearing on the
project. Processiarg time required for most ' IR's is approximately 4 toqmonths.
n TV OF HUNTINGT(N BEACH
PL kNNIN(3-r DIVISION
ENVIRONMENTAL ASSESSMI.NT 1+ ORM
Ening ce °87100
1. Any other entitlement application required by the Department of Community Development
shell be fled concurrently with this form. The foblowing information shall also accompany
this Environmental Assessment Form.
A. Dimensioned site plan, fic r plan, and elevations as applicable), including at minimum:
1. North arrow and scale of drawing,
2. Location of structures, both existing and proposed. and adjacent streets. Show
footprint of structures on adjacent property.
3. Location, type wad siza of existing trees and vegetation, and note wi ether trees and
vegetation will •:ernain or be removed,
4. Parking layout and means of access from adjacena streets.
5. Proposed landscaping and existing or proposed walls and fences.
B. Photographs of the area W sufticieerrt .letail to depict existing physical conditions in the
project area
C. Please attach copies of any ;special, studies that lu ve been prepared with regard to this
project or the project site, Examples would include: archaeological ;survey. hioi gical survey.
noise study, geotechnical report, .soils %port, traffic aanalysis. etc. Ia'not provided, these studies
may be required to complete the initial st.tiy.
Date Received:
EA Number:
("(..llc is applir°ablc:
Concurrent Entitlements:
C1 4
Ptcvious Entitlements:
yea --..
Assessor's Parcel No.:
OMMENTS:COMMENTS:-
rd Zone
trl Overlay Zone
Alqui; t-Prpo14 . rat
Methane Ov'erla
coastal Zone
i.e t= eiopment Area
)rical District
Ou
CITY Of HUNTIINGTON BEACH
PLANNING DIVISION
Inst. FA Form
ITY OF HUNT NGTON BEACH
PLANNING DIVISION
ENVIRONMENTAL ASSESSMENT FORM
GNUBAAI; iI LR A ON:
Name of Property Owner _e`==dr `i ing __._ __...._.
Address 1614 South Harbor Boulevard
City Fullerton State
Telephone 714-449-1000, X124
2. Name of Authorized Agent Sandy Rjarn
Address 16 14 South Harbor Boulevard.__...
City _Fullert on Stale
Telephone 714_,449-t000 , X113
Zip 9203''
Zip 92632
3. List any other relate I permits or approvals ,-or,uired front A.gencies other than City of
Huntington Beach, i.e. Caltrans, Coastal Cornmissuti°
T: 12e of permit
N/A
11aL...-.p ro'seci. give d
4. Is the proposal part of a' !arger project or series of projects"? It' so, describe the
proposal's relationsl p to the protect or s,:ries of projects:
LC,'F TAO EC T:
5. Address'8'032 Warner
6. Project site is located on flee north. south, .ast, west (circic on > w of
Warner
?i stre ets,
41OJECT DESCRIPTIO N-
'square7. Sipe size: 10,900 gross acre,,,
- -'N/A.._,___ net !Ms/.Square
;et
W hhat is the surrouu,:ing, land use to the
North Gas St;ation /Lit UDr-Grocery^ Sto.sr ,,
South Apa rents
East Professional Office .dg/Apar my t
Wiest R p°o 0 ficeBlcl _IM Its to Ti,c rf!e rt-a
FOR R IDENTIAI ,1E IT2-:(IF PROJEC I' IS C't) I Ella 1ZC'>.- 1.. INDUSTRIAL.,
INSTITUTIONAL SKIP TO ITEM 15.e
9. Number of lots and/or dwelling units:
and
Inst. EA Form
11
1,_i. Maximum buildmg, height and number of sto iwss:
11. Amount and type of oft=s±reo:t p aradug pro F
12. Describe any recreational facilities to be provided:
13. Describe the proposed scheduihig or pLasing of the projeoc;t'
14. What percentage of the project site will be covered by.
Paving Buildiag ins 0/0
FOR COMMERCIAL . IND ST RIA1091N aT I ill., 1 d . ` (IF l Rt.ill C
IS RESIDENTIAL SKIP TO ITEM 28)
15.Describe th9 ypes of uses and/or act.%it esproposed:I.ic ter "y Cc nnn ci
16.Size of eau. proposed building: tin gross s:guar°e t et g:Exist iug i3ui.1.f is 2839 SF
17.Number of buildings proposed.
18.Maximum building height and nun'her of stone,,;
19.Amount and ty-)e of off=stree t parking lprolp,,::,=;e is
20.Projected number o.` employees : -J "'r :Sh t
21.Maximum occupancy of huildinq4(
22.What will be the days and hours ol`operatioii.
aunt . 10 6; t=c_.__
,-i Mgr 10 am
23.Describe the proposed scheduling m' pliasin
For restaurants, how many seats wilt there N/A_..__
if outdoc seating is proposed amount of outdoor sctarc
25.What percentage of tho p¢: Wt siEe t ill he covered by.l ,i,s F!
Paving _....._..%, Building, 11,b=Iandsei."..xg
26.What is the distance of the protect iioni the nearest:
Schacl a r,o tely 2 miles
Hospital glpoxim ;.e1y 9 blocks
Convalescent Hospital ap ox tely locks
Park or Recreation Facility a ~2 oxi tc1.y 2 mi los
27. Does the project involP lae handling, manufacture, storage, tra ort or disposal of any
toxic, flammable or hazardous substance? No Ifso, p' rse describe and indicate
what safety measures have been incorporated into the project:
1ENVIRONMFJ TAL IMP CI' :
28. If improvements are to be demolished by the project, please outline them on ie site plan
and describe them briefly:N/A
29. Will the project potentially affect a historic structure or object in any way?_,.No If sso,
please describe:
30. List any potential noise sources which could af'fect the situ (i.e.. roadways, freeways,
equipment, machinery, etc.) N/A
31. Describe any noise that will be produced by the project during construction and after
project is completed:N/A
332. Will the project incorporate outdoor lighting?if If'so. indicate location and
source on the site plan.
33. Estimate the average number ofdaily vehicle trips (A].) l°) generated by the project site
currently after development .,N/
34. List type and quantity of any air pollutants that the project will ceatir.:N/A
35. Describe the type and source of any odors that may emant4atL from the project or she:
36. If the drainage from the project bill z of be di<eharged into an e .isting public storm water
drainage system, please describe hew it will be accornaiodated;/A
37. Has the project site been previously graded? If sck, what p crept
38. What percentage of the site will be graded as part of this pr«,ect''
39. Volume of cutting: N/ Cubic yards, maximum cut slope ratio v, ill be
40.
maximum, cut slope height wail be_ ,.:._..__.._.feet.
Volume of fill : 10 cubicyards; maxirnelmt till slope ratio "Al hemaximum fill slope height will be ---------feet.
41, Does the cut and fill volume balance?
handled?
N/A
How long will grading activities occur`.' w_
11 'not, how will import/export be
42. Identify species of plants and animals that are found on the site, and describe any areas of
vegetation to be removed (to be shown on accompanying site plan) .J .st.inr :r*e s
shrubs ass n-o - N
I nst. EA Form
,.. ..,- ;:,-.• .may,:. v.YY.r„InrkS ,'lar;p ..,-.° t^yar0,,¢?9tyf •Sw,,.. ^,aw,?:,e ,.
43. How will drainage fc e project be accoinniodated?.ing
44. What is the distance to the nearest beach. channel water via;M etland, degraded wetland,
or inland water area?apprpx a miles ._ {_.._D scribe how the project may affect any
body of water:pra-ie
45. What is the Flood Insurance Rate Map designation on the site?N/A If the site is in
46.
a floodplain, describe the method of floodproofing, and impacts of such flocciprooflng on
adjacent property. (A hydrology study may be requiredtt .,y._-__.-.._,.
47. Will the proje,-.t require installation or replacement of water lines?NO
Approximately how roan gallons of water per day will the project use?gallons.
49. Will the project require installation or replacement of sewer lines? No
Approximately how many gallons of sewage gallons.
49. Describe the typ e and amount (ounce per day) of solid waste generated by the project:ppx xana ply 100 lbs or animal shavings and an i marl waste
50. Will any resid-ntial occupants be displaced by the project:'
I b IG - TIO ND CON, ERVAT ON EAR-,URES a
51. What measures have been incorporated into the project. beyond what is rrequhed by
existing codes and standards tax
(a) Minimize erosion and siltation du
After completion''
(b) Minimize dust during constru..-tion of the-
After completion
(d) Minimize air pollution emissions?
ojec
n oftlie prof
(c) Minimize noise during construction of the proect."
wildlife, aesthetic quality, views, etc..am._.A_-,
;NJ A
(e) Protect, enhance or conserve energy, non-renewa ble resources, °,<;a,.er, veg
inst. EA Fornn
CERTIFICATION
I hereby certify that the statements furnished above and in the attached exhibits present the data
and information required for this initial evaluation to the best of my ability. utrd that the facts,
statements, and information presented are true and correct to the best of my knowledge or
belief.
Date I
Sandy Ryan
Print Name of Preparer
Signature of Pre er
Led Ying t y
or Authorized Agent
print Name of Prope:
Signature ofProperty
or Authorized Agent
Inst. EA Form 7-