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Part 5.COMPLIANCE WITH CALIFORNIA EN RONMENTAL 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(SCH#): <br /> ENVIRONMENTAL IMPACT REPORT(EIR)SCH# <br /> F-JNEGATIVE 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 /> F-�CATEGORICAL/STATUTORY 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 /> ®RFI/JTD ®ENVIRONMENTAL DOCUMENT(S): <br /> ❑LOCAL USE/PLANNING PERMITS ❑EIR <br /> ®LOCATION MAP ❑MND/ND <br /> ®MITIGATION MONITORING IMPLEMENTATION SCHEDULE D4�1 MPTION <br /> ❑ADDENDUM <br /> B. ADDITIONAL REQUIRED DOCUMENTS FOR LANDFILLS ONLY: <br /> ®OPERATING LIABILITY FINANCIAL MECHANISM ®FINANCIAL RESPONSIBILITY DOCUMENTATION <br /> ®CLOSURE/POST CLOSURE MAINTENANCE PLAN ®LANDFILL CAPACITY SURVEY RESULTS(see instructions) <br /> ❑ PRELIMINARY <br /> ❑ FINAL <br /> C. IF APPLICABLE: <br /> ®REPORT OF WASTE DISCHARGE ®DEPT.OF HEALTH SERVICES PERMIT <br /> ®CONTRACT AGREEMENTS ®SWAT(Air and water) <br /> ®STORMWATER PERMIT APPLICATION ®WETLANDS PERMITS <br /> ®NPDES PERMIT APPLICATION/ ®VERIFICATION OF FIRE DISTRICT COMPLIANCE <br /> ;jCfHER <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 PARTNERSHIPRPORATION ®GOVERNMENT AGENCY <br /> OWNER(S)OF LAND SSN OR TAX ID# <br /> (Name): <br /> 77 we- <br /> ADDRESS, <br /> Z <br /> ADDRESS,CITY,STATE,ZIP TELEPHONE#: <br /> /Co y�/ ,�'• LJ®� S7.vc� �, - �3.3/- lye o <br /> FAX#: <br /> 17 W!v <br /> E-MAIL ADDRESS: <br /> T/ASS IV ):7I-' !P r- e-007 <br /> CONTACT PERSON(Print Name): <br /> Page 3 <br />