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• r <br /> Part S.COMPLIANCE WITH CALIFORNIA ENVIRONMENTAL QUALITY ACT(CEQA)(Check applicable boxes) <br /> A. CHECK BOX(ES)IF ENVIRONMENTAL DOCUMENT WAS OR WILL BE PREPARED FOR THIS PROJECT AND PROVIDE THE STATE CLEARINGHOUSE NUMBER(BCH#): <br /> F-JENVIRONMENTAL IMPACT REPORT(EIR)BCH# <br /> ®NEGATIVE DECLARATION(ND)/mrnr.ATED NEGATIVE DECLARATION(MND)BCH# ,93 I D Z,®34 CI P, c1 Dec, z o l 93 3 <br /> aADDENDUM TO(Identify environmental document) BCH# <br /> B. IF ENVIRONMENTAL DOCUMENT(S)WAS NOT PREPARED,PLEASE PROVIDE THE FOLLOWING INFORMATION: <br /> r--ICATEGORICALISTATUTORY EXEMPTION(CE/SE) . <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 /> EJRFI/JTD QFi/2,fr>1 d4ry't +F-b. II, /991 ENVIRONMENTALDOCUMENT(S): <br /> ®LOCAL USE/PLANNING PERMITS Nd® SA-33-4I d A-reA .'Z 111993 ❑EIR <br /> LOCATION MAP 56-F- 4 7rAGlt rcl MND/ND /IOD dA-TgcJ <br /> MITIGATION MONITORING IMPLEMENTATION SCHEDULE ❑EXEMPTION <br /> ❑ADDENDUM <br /> B. ADDITIONAL REQUIRED DOCUMENTS FOR LANDFILLS ONLY: <br /> OPERATING LIABILITY FINANCIAL MECHANISM E]FINANCIAL RESPONSIBILITY DOCUMENTATION <br /> ❑CLOSUREIPOST CLOSURE MAINTENANCE PLAN LANDFILL CAPACITY SURVEY RESULTS(see instructions) <br /> ❑ PRELIMINARY <br /> ❑ FINAL <br /> C. IF APPLICABLE: <br /> REPORT OF WASTE DISCHARGE tn/EI I UE�'i r 12OAA CRWQC -CVQDEPT.OF HEALTH SERVICES PERMIT <br /> f-ICONTRACTAGREEMENTS �ATlEd. 5Ep.Z2/19-93 ❑SWAT(Air and water) <br /> F-1STORMWATER PERMIT APPLICATION ❑WETLANDS PERMITS <br /> F�NPDESPERMIT APPLICATION EIVERIFICATIONOFFIRE DISTRICT COMPLIANCE F<)/A LIA1c1eW-Pel&-es FI12F ®izICT <br /> OTHER <br /> Part 7.OWNER INFORMATION (For disposal site,if operator is different from landowner,attach lease or other agreement) <br /> TYPE OF BUSINESS: <br /> SOLE PROPRIETORSHIP PARTNERSHIP ®CORPORATION F-1GOVERNMENTAGENCY <br /> OWNER(S)OF LAND SSN OR TAX ID# <br /> (Name): <br /> ADDRESS,CITY,STATE,ZIP TELEPHONE M <br /> 209 - 087--304-S <br /> FAX M. <br /> 2339 a FGot�d 12d . <br /> 2-09- 007- 38-90 <br /> L/Ard t CA 95Z365, <br /> E-MAIL ADDRESS: <br /> L,t-e-it, hdLt0A-; SCartt.S_ G D wt <br /> CONTACT PERSON(Print Name): <br /> 8 9E7AlT 80 LTO/J <br /> Page 3 <br />