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Paeck applCa aboxes) <br /> A. CHECK BOX(ES)IF ENVIRONMENTAL DOCUMENT WAS OR WILL BE PREPARED FOR THIS PROJECT: <br /> X❑ 1.ENVIRONMENTAL DOCUMENT WAS PREPARED: <br /> M ENVIRONMENTAL IMPACT REPORT(EIR)SCH# 90020924 <br /> NEGATIVE DECLARATION(ND)/MITIGATED NEGATIVE DECLARATION(MND)SCH# <br /> ADDENDUM TO(Identify environmental document) SCH# <br /> 2.ENVIRONMENTAL DOCUMENT WILL BE PREPARED(Enter lead agency if known): <br /> B. IF ENVIRONMENTAL DOCUMENT(S)WAS NOT PREPARED,PLEASE PROVIDE THE FOLLOWING INFORMATION: <br /> CATEGORICAL/STATUTORY EXEMPTION(CE/SE) <br /> EXEMPTION TYPE GUIDELINE# <br /> Part l In the date tor each document checked) <br /> A.REQUIRED WITH ALL APPLICATION SUBMITTALS: <br /> ® RFI/JTD Revised pages attached © ENVIRONMENTAL DOCUMENT(S): <br /> LOCATION MAP Revised pages attached eEIR 90020924 <br /> ® MITIGATION MONITORING&REPORTING PROGRAM Previously submitted ❑MND/ND <br /> El LIST OF PUBLIC HEARINGS AND OTHER MEETINGS OPEN TO THE PUBLIC ❑EXEMPTION <br /> ❑ADDENDUM <br /> B. ADDITIONAL REQUIRED DOCUMENTS FOR DISPOSAL FACILITIES NLY <br /> ® OPERATING LIABILITY FINANCIAL MECHANISM ® FINANCIAL RESPONSIBILITY DOCUMENTATION <br /> CLOSURE/POST CLOSURE MAINTENANCE PLAN ® KNOWN OR REASONABLY FORSEEABLE CORRECTIVE ACTION COST ESTIMATES <br /> ❑PRELIMINARY <br /> ❑FINAL LANDFILL CAPACITY SURVEY RESULTS(see instruct <br /> C. IF APPLICABLE: <br /> REPORT OF WASTE DISCHARGE DEPT.OF TOXIC SUBSTANCES CONTROL OR CERTIFIED UNIFIED <br /> PROGRAM AGENCY PERMIT <br /> NPDES PERMIT APPLICATION WETLANDS PERMITS <br /> U I HtR VERIFIUA I IUN OF FIRt DIJ I RIU I (;UMPLIAN(;t <br /> PAFf 7. S I Sitp If nnprat(N IS rfiffP.rpnf frnm and ownpr.affa(:h 1paSp rN(lthpr aOrppmpnt) <br /> TYPE OF BUSINESS: <br /> ❑ SOLE PROPRIETORSHIP ❑ PARTNERSHIP Xl CORPORATION ❑ GOVERNMENT AGENCY <br /> OWNER(S)OF LAND SSN OR TAX ID# <br /> (Na USA Waste of California Inc.dba Central Valley Waste Services 68-0306154 <br /> ADDRESS,CITY,STATE,ZIP TELEPHONE#: <br /> 1333 East Turner Road, P.O. Box 241001, Lodi, CA 95241 209-333-5644 <br /> FAX#: <br /> E-MAIL ADDRESS: <br /> gpineda@wm.com <br /> CONTACT PERSON(Print Name): <br /> Gilbert Pineda <br /> Page 3 <br />