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Part 5.COMPLIANCE WITH CALIFORNIA ENVIRONMENTAL QUALITY ACT(CEQA)(Check applicable boxes) <br /> A. CHECK BOX(ES)IF ENVIRONMENTAL DOCUMENT WAS OR WLL BE PREPARED FOR THIS PROJECT AND PROVIDE THE STATE CLEARINGHOUSE NUMBER(SCH#) <br /> ®ENVIRONMENTAL IMPACT REPORT(EIR)SCH# <br /> ®NEGATIVE DECLARATION(NDyMITIGATED NEGATIVE DECLARATION(MND)SCH# 2010112045 <br /> MADDENDUM TO(Identify environmental document) SCH# <br /> B. IF ENVIRONMENTAL DOCUMENT(S)WAS NOT PREPARED,PLEASE PROVIDE THE FOLLOWING INFORMATION <br /> MCATEGORICAL/STATUTORY EXEMPTION(CEISE) <br /> EXEMPTION TYPE GUIDELINE# <br /> Part 6.LIST OF ATTACHMENTS(Fill in the date for each document checked) <br /> A.REQUIRED WITH ALL APPLICATION SUBMITTALS: <br /> ®RFI/JTD Amended pages,figures,and drawings(see Pan 10) MENVIRONMENTAL DOCUMENT(S) <br /> ®LOCAL USEIPLANNING PERMITS Apr-03 13 EIR <br /> ®LOCATION MAP Included as Sheet 1 of 14 of Amended Pages X MND#ND SCH#2010112045 <br /> ®MITIGATION MONITORING IMPLEMENTATION SCHEDULE Dec 02 O EXEMPTION <br /> O ADDENDUM <br /> B. ADDITIONAL REQUIRED DOCUMENTS FOR LANDFILLS ONLY: <br /> ®OPERATING LIABILITY FINANCIAL MECHANISM May 2006 QFINANCIAL RESPONSIBILITY DOCUMENTATION Feb-06 <br /> [E]CLOSURE/POST CLOSURE MAINTENANCE PLAN XMLANDFILL CAPACITY SURVEY RESULTS(see Instructions) Mar-1 t <br /> X PRELIMINARY In Appendix L of JTD dated 5/2002 <br /> O FINAL <br /> C. IF APPLICABLE: <br /> ®REPORT OF WASTE DISCHARGE []DEPT OF HEALTH SERVICES PERMIT <br /> MCONTRACT AGREEMENTS ❑SWAT(Ax and water) <br /> MSTORMWATER PERMIT APPLICATION ®WETLANDS PERMITS <br /> MNPDES PERMIT APPLICATION ®VERIFICATION OF FIRE DISTRICT COMPLIANCE <br /> MOTHER <br /> � omimer�w�nnaomnr�oevnm oi�nnanniu ie <br /> Part T.OWNER INFORMATION (For disposal site,if operator is different from land owner,attach lease or other agreement) <br /> TYPE OF BUSINESS: <br /> MSOLEPROPRIETORSHIP PARTNERSHIP INCORPORATION ®GOVERNMENT AGENCY <br /> OWNER(S)OF LAND SSN OR TAX ID# <br /> (Name) <br /> Forward, Inc. 941544481 <br /> ADDRESS,CITY STATE,ZIP TELEPHONE# <br /> 209.982.4298 <br /> FAX# <br /> 209.982.1009 <br /> 9999 S.Austin Road, Manteca, CA 95336 E-MAIL ADDRESS <br /> d litchfieldl'ly reaublicse rvices.com <br /> CONTACT PERSON(Print Name) <br /> Don Litchfield <br /> Page 3 <br />