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Part�5.COMPLIANCE WITH CAL ENVIRq&NTAL QUALITY ACT(CEQA)(Check appl' boxes) <br /> A. CHECK BOX(ES)IF ENVIRONMENTAL DOCUMENT WAS OR WILL BE PREPARED FOR THIS PROJECT AND PROVIDE THE STATE CLEARINGHOUSE NUMBER(SCH#): <br /> X❑ENVIRONMENTAL IMPACT REPORT(EIR)SCH# 9209072 February 1994 <br /> ®NEGATIVE DECLARATION(ND)/MITIGATED NEGATIVE DECLARATION(MND)SCH# <br /> ®ADDENDUM TO(Identify environmental document) SCH# <br /> B. IF ENVIRONMENTAL DOCUMENT(S)WAS NOT PREPARED,PLEASE PROVIDE THE FOLLOWING INFORMATION: <br /> OCATEGORICAUSTATUTORY 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 /> x—lRFI/JTD TPR dated April,2015 EIENVIRONMENTAL DOCUMENT(S): <br /> ®LOCAL USE/PLANNING PERMITS UP-93-2(Oct 1993) o EIR SCH#9209072 February 1994 <br /> ®LOCATION MAP See TPR o MND/ND <br /> X�MITIGATION MONITORING IMPLEMENTATION SCHEDULE 6-Jul-93 o EXEMPTION <br /> ❑ADDENDUM <br /> B. ADDITIONAL REQUIRED DOCUMENTS FOR LANDFILLS ONLY: NA-Not a landfill <br /> ®OPERATING LIABILITY FINANCIAL MECHANISM ®FINANCIAL RESPONSIBILITY DOCUMENTATION <br /> DCLOSURE/POST CLOSURE MAINTENANCE PLAN ®LANDFILL CAPACITY SURVEY RESULTS(see instructions) <br /> ❑ PRELIMINARY <br /> ❑ FINAL <br /> C. IF APPLICABLE: <br /> REPORT OF WASTE DISCHARGE NA ODEPT.OF HEALTH SERVICES PERMIT <br /> CONTRACT AGREEMENTS ❑SWAT(Air and water) <br /> ®STORMWATER PERMIT APPLICATION OWETLANDS PERMITS <br /> EJNPDES PERMIT APPLICATION VERIFICATION OF FIRE DISTRICT COMPLIANCE <br /> MOTHER <br /> Part 7.OWNER INFORMATION (For disposal site,if operator is different from land owner,attach lease or other agreement) <br /> TYPE OF BUSINESS: <br /> ®SOLE PROPRIETORSHIP ❑PARTNERSHIP ®CORPORATION XEGOVERNMENTAGENCY <br /> OWNER(S)OF LAND SSN OR TAX ID# <br /> (Name): <br /> San Joaquin Coun!y Department of Public Works Solid Waste Division 6800-14563 <br /> ADDRESS,CITY,STATE,ZIP TELEPHONE#: <br /> PO Box 1810,Stockton CA 95201 209-468-3066 <br /> FAX#: <br /> 209-468-3078 <br /> E-MAIL ADDRESS: <br /> tbahadori sigov.ora <br /> CONTACT PERSON(Print Name): <br /> Ta'Bahadori <br /> Lovelace Permit Modification 2015 Printed 10/20/2015 <br />