Non-Applicant Business Concern Disclosure Form

NON-APPLICANT BUSINESS CONCERN DISCLOSURE FORM (PRIVATE AND GOVERNMENT ENTITIES) This form must be completed by Non-Applicant Business Concerns which have a relationship with the Applicant that requires them to file a disclosure statement. Applicant means any person: (1) Seeking a permit, other than a permit modification, or license for an off-site waste facility; (2) Holding a permit or license for an off-site waste facility; or (3) Who is a prospective owner of an off-site waste facility. This form must be completed any Non-Applicant Business Concern that: (1) Directly holds, or are able to control through a subsidiary or holding company, any equity in or debt liability of the Applicant, if the Applicant is a privately held business concern; (2) Directly holds, or are able to control through a subsidiary or holding company, more than five (5) percent equity in or debt liability of the Applicant, if the Applicant is a publicly traded corporation; (3) Is a partner of the Applicant; (4) Is a subsidiary of the Applicant and collects, transfers, transports, treats, stores, or disposes of solid waste, infectious waste, or hazardous waste; (5) Is the operator of an off-site facility for which the Applicant is a government entity; and (6) Is a partner of the operator of an off-site facility for which the Applicant is a government entity and the operator is not an employee of the government entity. Pursuant to O.R.C. 3734.41-3734.47 and O.A.C. Sections 109:6-1-01 through 109:6-1-05 American LegalNet, Inc. www.FormsWorkFlow.com NON-APPLICANT BUSINESS CONCERN DISCLOSURE FORM 1. WHO MUST COMPLETE THIS FORM. Any business concern that: a. Directly holds, or is able to control through a subsidiary or holding company, any equity in or debt liability of an Applicant, if the Applicant is a privately held business concern; ALL business concerns that hold equity in or debt liability of the Applicant must complete this form. This form is not limited to business concerns that own or control the Applicant. b. Directly holds, or is able to control through a subsidiary or holding company, more than per cent equity in or debt liability of the Applicant, if the Applicant is a publicly traded corporation; ALL business concerns that hold more than 5 percent equity in or debt liability of the Applicant must complete this form. This form is not limited to business concerns that own or control the Applicant. c. Is a partner of the Applicant; d. Is a subsidiary of the Applicant and collects, transfers, transports, treats, stores, or disposes of solid waste, infectious waste, or hazardous waste; e. Is the operator of an off-site facility for which the Applicant is a government entity; and f. Is a partner of the operator of an off-site facility for which the Applicant is a government entity and the operator is not an employee of the government entity. As defined by OAC 109:6-1-01(E), "Business concern" means any corporation, association, firm, partnership, trust, sole proprietorship, or other form of commercial organization. 2. ALL QUESTIONS MUST BE ANSWERED. Read every question carefully before answering any question. Answer every question completely. Do not leave any blank spaces. If a question does not apply to you, enter "Not applicable" or "N/A" in the space provided for an answer. If there is nothing to disclose in an answer to a particular question, enter "None" in the space provided for an answer. ANSWER COMPLETELY AND TRUTHFULLY. Failure to answer any questions completely may result in your statement being returned to you for supplementation of your answer. If the answer to a question in this form is identical to an answer previously given to a question in the form, you may answer the later question by writing "Same as ." For example, if the answer to Question 3 is the same as the answer to Question 2, you may answer Question 3 by writing "Same as 2". ADDITIONAL SPACE. If you need additional space to answer a question, use plain 8 ½" x 11" paper. Insert additional pages immediately following the page on which the question you are answering appears. Be sure to indicate that your answer to the question is "continued on next Page," and indicate on the additional page which question is being continued there. When you have finished answering all questions, and have attached all additional pages, consecutively number each page at the top right corner ­ including the additional pages. Pages of 3. 4. American LegalNet, Inc. www.FormsWorkFlow.com the original form, which need to be renumbered as a result of adding pages, should be renumbered at the space provided after "Your Page No. ." 5. EXHIBITS. If you are required or wish to submit any document in connection with your answer to any question, refer to it in your answer as, for example, "Exhibit No.," and attach it at the end of the form. TYPE OR PRINT YOUR ANSWERS. Type or print in legible block letter style. Handwritten forms will be returned if entries are in script or are unreadable. DO NOT USE A SCRIPT TYPEFACE. INTERPRETIVE ASSISTANCE IN COMPLETING DISCLOSURE STATEMENTS. If you need interpretive assistance in completing a disclosure statement, you may submit in writing to the Attorney General a regulatory guidance request seeking an informal, non-binding interpretation of a regulatory requirement imposed by Sections 3734.41 to 3734.47 of the Ohio Revised Code and the rules adopted thereunder. The information required to be submitted in the disclosure statement is intended to be the information necessary to begin the background investigation required by Sections 3743.41 through 3734.47 of the Ohio Revised Code. By signing the Release Form below you agree to allow the Attorney General to check your background for administrative, civil, and criminal violations, your credit history, and report this information to the Ohio EPA. In limiting the scope of information required to be included in the disclosure statement, it is expressly contemplated that in individual investigations, the Attorney General may have reasonable cause to engage in additional review of the business concern. Nothing contained herein shall be construed to restrict or limit the scope of the information the Attorney General may seek pursuant to the procedures established in Sections 3734.43 of the Ohio Revised Code. 6. 7. 8. IF YOU HAVE GENERAL QUESTIONS ABOUT HOW TO FILL OUT THIS FORM, CALL THE ATTORNEY GENERAL'S OFFICE AT (614) 466-3843. American LegalNet, Inc. www.FormsWorkFlow.com