Content of Disclosure Statement Forms

Content of Disclosure Statement Forms. The disclosure statement shall be filed on forms supplied by the Department and shall contain the following information: A. Applicant Identity. A description of the business structure of the entity making the application, i.e., whether the applicant is an individual, a partnership, a corporation or some other type of business concern. B. Applicant Information. (1) Individual. If the applicant is an individual, applicant's: (a) Full name; (b) Business address; (c) Date of birth; (d) Social security number; (e) Business telephone number. (2) Business Concern. If the applicant is a business concern, applicant's: (a) Full name; (b) Business address; (c) Date of establishment; (d) Federal employer identification number; (e) Business telephone number. C. Business Concern Applicant's Personnel. For each officer, director, partner or key employee of the applicant, such person's: (1) Full name; (2) Business address; (3) Date of birth; (4) Social security number; (5) Business telephone number; (6) Position, i.e., officer, director, partner, key employee. D. Holders of Equity or Debt Liability in Business Concern Applicants. (1) Business Concern Applicant that is not a Publicly Traded Corporation. (a) If the business concern applicant is not a publicly traded corporation, for each person other than a business concern holding an equity interest in such applicant business concern, such person's: (1) Full name; (2) Business address; (3) Date of birth; (4) Social security number; (5) Business telephone number; (6) Percentage of equity held. (b) If the business concern applicant is not a publicly traded corporation, for each business concern (other than an investment company which is publicly traded or a chartered lending institution) which is an equity holder of the applicant business concern, such business concern's: (1) Full name; (2) Business address; (3) Date of establishment; (4) Federal employer identification number; (5) Business telephone number; (6) Percentage of equity held. (c) If the business concern applicant is not a publicly traded corporation, for each investment company which is publicly traded or chartered lending institution holding equity in such applicant business concern, such investment company's or lending institution's: (1) Full name; (2) Business address; (3) Business telephone number; (4) Percentage of equity held. (d) If the business concern applicant is not a publicly traded corporation, a listing of all persons or business concerns holding debt liability in such applicant business concern shall be provided with such listing to include the following information for such persons or business concerns: (1) Full name; (2) Business address; (3) Federal employer identification number, if applicable; (4) Amount of debt liability held in U.S. Dollars; and (5) Percentage of the total debt liability held. For the purposes of Rule 7.5(D)(1)(d), persons and business concerns holding debt liability in the applicant business concern and disclosed pursuant to Rule 7.5(D)(1)(d) are not subject to further disclosure requirements and shall not be considered a "disclosed business concern" unless expressly requested by the permit board. (2) Publicly Traded Corporation Applicant. (a) If the applicant business concern is a publicly traded corporation, for individuals related within the third degree holding a cumulative of five percent (5%) and for any other person (other than a business concern) holding more than five percent (5%) of the equity in such publicly traded corporation, such person's: (1) Full name; (2) Business address; (3) Date of birth; (4) Social Security number; (5) Business telephone number; (6) Percentage of equity held. (b) If the applicant business concern is a publicly traded corporation, for each business concern (other than an investment company which is publicly traded or a chartered lending institution holding equity or debt liability of a business concern disclosed in applicant's disclosure statement) holding more than five percent (5%) of the equity in such publicly traded corporation, such business concern's: (1) Full name; (2) Business address; (3) Date of establishment; (4) Federal employer identification number; (5) Business telephone number; (6) Percentage of equity held. (c) If the applicant business concern is a publicly traded corporation, for each investment company which is publicly traded or chartered lending institution holding more than five percent (5%) of the equity in such publicly traded corporation, such investment company's or lending institution's: (1) Full name; (2) Business address; (3) Business telephone number; (4) Percentage of equity held. (d) If the applicant business concern is a publicly traded corporation, a listing of all individuals or business concerns holding more than five percent (5%) or individuals related within the third degree holding a cumulative of five percent (5%) or more of the debt liability in the applicant business concern shall be provided with such listing to include the following information for such persons or business concerns: (1) Full name; (2) Business address; (3) Federal employer identification number, if applicable; (4) Amount of debt liability held in U.S. Dollars; and (5) Percentage of the total debt liability held. For the purposes of Rule 7.5(D)(2)(d), persons and business concerns holding debt liability in the applicant business concern and disclosed pursuant to Rule 7.5(D)(2)(d) are not subject to further disclosure requirements and shall not be considered a "disclosed business concern" unless expressly requested by the permit board. E. Disclosed Business Concern Information. (1) Officers, Directors, and Partners. For each officer, director or partner of any business concern disclosed in the statement supplied pursuant to these Regulations (other than an investment company which is publicly traded or a chartered lending institution), such person's: (a) Full name; (b) Business address; (c) Date of birth; (d) Social security number; (e) Business telephone number; (f) Position, i.e., officer, director, partner, key employee as defined in Rule 7.3(P) of these Regulations. (g) Employer's name, company name or business name. (2) Equity and Debt Liability Holders. (a) Disclosed Business Concern that is not a Publicly Traded Corporation. (1) If the business concern applicant is not a publicly traded corporation, for each person other than a business concern holding equity in the disclosed business concern, such person's: (i) Full name; (ii) Business address; (iii) Date of birth; (iv) Social security number; (v) Business telephone number; (vi) Percentage of equity held. (2) If the disclosed business concern is not a publicly traded corporation, for each business concern (other than an investment company which is publicly traded or a chartered lending institution) which is an equity holder of the disclosed business concern, such business concern's: (i) Full name; (ii) Business address; (iii) Date of establishment; (iv) Federal employer identification number; (e) Business telephone number; (v) Percentage of equity held. (3) If the disclosed business concern is not a publicly traded corporation, for each investment company which is publicly traded or chartered lending institution holding equity in such disclosed business concern, such investment company's or lending institution's: (i) Full name; (ii) Business address; (iii) Business telephone number; (iv) Percentage of equity held. (4) If the disclosed business concern is not a publicly traded corporation, a listing of all persons or business concerns holding debt liability in such disclosed business concern shall be provided with such listing to include the following information for such persons or business concerns: (i) Full name; (ii) Business address; (iii) Federal employer identification number, if applicable; (iv) Amount of debt liability held in U.S. Dollars; and (v) Percentage of the total debt liability held. For the purposes of Rule 7.5(E)(2)(a)(4), persons and business concerns holding debt liability in disclosed business concerns and disclosed pursuant to Section Rule 7.5(E)(2)(a)(4) are not subject to further disclosure requirements and shall not be considered a "disclosed business concern" unless expressly requested by the Permit Board. (b) Publicly Traded Corporation Disclosed Business Concern. (1) If the disclosed business concern is a publicly traded corporation, for individuals related within the third degree holding a cumulative of five percent (5%) and for any other person (other than a business concern) holding more than five percent (5%) of the equity in such publicly traded corporation, such person's: (i) Full name; (ii) Business address; (iii) Date of birth; (iv) Social Security number; (v) Business telephone number; (vi) Percentage of equity held. (2) If the disclosed business concern is a publicly traded corporation, for each business concern (other than an investment company which is publicly traded or a chartered lending institution holding equity in a business concern disclosed in applicant's disclosure statement) holding more than five percent (5%) of the equity in such publicly traded corporation, such business concern's: (i) Full name; (ii) Business address; (iii) Date of establishment; (iv) Federal employer identification number; (v) Business telephone number; (vi) Percentage of equity held. (3) If the disclosed business concern is a publicly traded corporation, for each investment company which is publicly traded or chartered lending institution holding more than five percent (5%) of the equity in such publicly traded corporation, such investment company's or lending institution's: (i) Full name; (ii) Business address; (iii) Business telephone number; (iv) Percentage of equity held. (4) If the disclosed business concern is a publicly traded corporation, a listing of all individuals and business concerns holding more than five percent (5%) or individuals related within the third degree holding a cumulative of five percent (5%) or more of the debt liability in the disclosed business concern shall be provided with such listing to include the following information for such persons or business concerns: (i) Full name; (ii) Business address; (iii) Federal employer identification number, if applicable; (iv) Amount of debt liability held in U.S. Dollars; and (v) Percentage of the total debt liability held. For the purposes of Rule 7.5(E)(2)(b)(4), persons and business concerns holding debt liability in disclosed business concerns and disclosed pursuant to Rule 7.5(E)(2)(b)(4) are not subject to further disclosure requirements and shall not be considered a "disclosed business concern" unless expressly requested by the permit board. (F) Applicant's Interest in Waste Business Concerns. For each business concern that collects, transports, treats, processes, stores or disposes of nonhazardous solid waste or hazardous waste in which the applicant holds an equity interest of five percent (5%) or more, such business concern's: (1) Full name; (2) Business address; (3) Date of establishment; (4) Federal employer identification number; (5) Business telephone number. (G) Applicant's Business Experience and Credentials. (1) If the applicant is a person other than a business concern, a description of the business experience and credentials of the applicant, including any past or present permits or licenses, possessed by the applicant, for the treatment, processing, storage or disposal of nonhazardous solid waste or hazardous waste. (2) If the applicant is a business concern, a description of the business experience and credentials of the applicant's key employee(s), officers, directors and/or partners, including any past or present permits or licenses, possessed by such persons for the treatment, processing, storage or disposal of nonhazardous solid waste or hazardous waste. (H) History of Related Business Concerns. (1) If the applicant is seeking a permit to operate and/or construct a commercial nonhazardous solid waste management facility and either the applicant or a parent business concern has engaged in the commercial treating, processing, storage or disposal of nonhazardous solid waste in Mississippi for fewer than five (5) years preceding the filing of its application or if the applicant is seeking a permit to operate and/or construct a commercial hazardous waste management facility and either the applicant or a parent business concern has engaged in the commercial treating, processing, storage or disposal of hazardous waste in Mississippi for fewer than five (5) years preceding the filing of its application, the following information about each sister business concern of applicant that has engaged in the commercial treating, processing, storage or disposal of nonhazardous solid waste or hazardous waste within such five-year period: (a) Full name; (b) Business address; (c) Date of establishment; (d) Federal employer identification number; (e) Business telephone number. (2) If neither the applicant nor its parent business concern(s) nor any sister business concern of the applicant has engaged in the commercial treating, processing, storage or disposal of nonhazardous solid waste or hazardous waste within the five-year period preceding the filing of its application, provide the following information about any sister business concerns that, within the five-year period preceding the filing of applicant's application, have been the subjects of any enforcement actions: (a) Full name; (b) Business address; (c) Date of establishment; (d) Federal employer identification number; (e) Business telephone number; (f) Listing and explanation of each such enforcement action [include the name and address of the regulatory agency involved]. (I) Environmental History. Any person required to be disclosed in the disclosure statement, except a person required to be disclosed pursuant to Rule 7.5(h)(2) of these Regulations, shall provide a listing and explanation of any: (1) notices of violation; (2) prosecutions; (3) administrative orders (whether by consent or otherwise); (4) license or permit revocations or suspensions; and, (5) enforcement actions by any state or federal authority within the five- year period immediately preceding the filing of the application, which are pending or have concluded in a finding of violation or entry of a consent agreement regarding any allegation of the civil or criminal violation of any law, regulation or requirement related to the treatment, processing, storage or disposal of nonhazardous solid waste or hazardous waste [include the name and address of the regulatory agency involved]. (J) Felony Information. For each person required to be disclosed in the disclosure statement, an itemized list of any and all final convictions of and pleas of guilty or nolo contendere to any crime punishable as a felony in any jurisdiction within the five-year period immediately preceding the filing of the application [include the name of the jurisdiction in which the conviction(s) and/or plea(s) occurred]. (K) Nonhazardous Solid Waste or Hazardous Waste Agency Information. (1) A listing of each agency outside of Mississippi that has or has had regulatory responsibility over the applicant regarding the applicant's treatment, processing, storage or disposal of nonhazardous solid waste or hazardous waste within the five-year period immediately preceding the filing of the application. (2) A listing of each agency outside of Mississippi that has or has had regulatory responsibility over a parent, subsidiary or sister business concern of applicant regarding such parent, subsidiary or sister business concern's treatment, processing, storage or disposal of nonhazardous solid waste or hazardous waste within the five-year period immediately preceding the filing of the application. This disclosure need be made concerning sister business concerns only if such sister business concern is required to be disclosed under Rule 7.5(h), supra. (L) Other Related Information. Applicant shall provide any other information the Mississippi Environmental Quality Permit Board may require prior to making its decision concerning the issuance, reissuance or transfer of a permit.