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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 /> OENVIRONMENTAL 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 /> F-1CATEGORICAUSTATUTORY 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/JTO ENVIRONMENTAL DOCUMENT(S): <br /> LOCAL USE/PLANNING PERMITS 0 EIR <br /> LOCATION MAP ❑MND/ND <br /> ❑MITIGATION MONITORING IMPLEMENTATION SCHEDULE ❑EXEMPTION <br /> O ADDENDUM <br /> B. ADDITIONAL REQUIRED DOCUMENTS FOR LANDFILLS ONLY: 0 /� <br /> ®OPERATING LIABILITY FINANCIAL MECHANISM /` ❑FINANCIAL RESPONSIBILITY DOCUMENTATION <br /> CLOSURE/POST CLOSURE MAINTENANCE PLAN LANDFILL CAPACITY SURVEY RESULTS(see instructions) <br /> O PRELIMINARY <br /> ❑ FINAL <br /> C. IF APPLICABLE: <br /> ®REPORT OF WASTE DISCHARGE MDEPT.OF HEALTH SERVICES PERMIT <br /> CONTRACT AGREEMENTS SWAT(Air and water) <br /> ®STORMWATER PERMIT APPLICATION M WETLANDS PERMITS <br /> MNPDES PERMIT APPLICATION VERIFICATION OF FIRE DISTRICT COMPLIANCE <br /> OTHER <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 /> EISOLE PROPRIETORSHIP PARTNERSHIP CORPORATION 0GOVERNMENTAGENCY <br /> OWNER(S)OF LAND SSN OR TAX ID# <br /> (Name): n <br /> -�v' <br /> ADDRESS,CITY,STATE IP n ' TELEPHONE#: <br /> ox V <br /> bwq— La <br /> FAX#: <br /> q- 5q ( r Coq d-IT <br /> E-MAIL ADDRESS: <br /> �'a fCkel <br /> CONTACT PERSON(Print Name): <br /> 'RCS- ot , G <br /> Page 3 <br />