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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 WILL BE PREPARED FOR THIS PROJECT AND PROVIDE THE STATE CLEARINGHOUSE NUMBER(SCH#): <br /> ENVIRONMENTAL IMPACT REPORT(EIR)SCH# <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 /> ❑CATEGORICAUSTATUTORY 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 /> M RFI/JTD <br /> ENVIRONMENTAL DOCUMENT(S): <br /> LOCAL USE/PLANNING PERMITS ❑EIR <br /> LOCATION MAP 11 MND/ND <br /> ®MITIGATION MONITORING IMPLEMENTATION SCHEDULE ❑EXEMPTION <br /> ❑ADDENDUM <br /> B. ADDITIONAL REQUIRED DOCUMENTS FOR LANDFILLS ONLY: <br /> ❑OPERATING LIABILITY FINANCIAL MECHANISM fFINANCIAL RESPONSIBILITY DOCUMENTATION <br /> aCLOSURE/POST CLOSURE MAINTENANCE PLAN LANDFILL CAPACITY SURVEY RESULTS(see instructions) <br /> O 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 /> E]STORMWATER PERMIT APPLICATION WETLANDS PERMITS <br /> ❑NPDES 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 /> E]SOLEPROPRIETORSHIP PARTNERSHIP CORPORATION r-1 GOVERNMENT AGENCY <br /> OWNER(S)OF LAND SSN OR TAX ID# <br /> (Name): n <br /> RaLk- ��0001 <br /> OM& N&C <br /> ADDRESS,CITY,STATE IP TELEPHONE#: <br /> FAX#: <br /> Gk ' C f--� qct 0- oq �- <br /> E-MAIL ADDRESS: <br /> CONTACT PERSON(Print Name): <br /> Rd�'0-� C t+ -z-, <br /> Page 3 <br />