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A. CHECK BOX(ES) IF ENVIRONMENTAL DOCUMENT WAS OR WILL BE PREPARED FOR THIS PROJECT: <br />X❑ 1. ENVIRONMENTAL DOCUMENT WAS PREPARED: <br />® ENVIRONMENTAL IMPACT REPORT (EIR) SCH# 90020924 <br />® NEGATIVE DECLARATION (ND)/MITIGATED NEGATIVE DECLARATION (MND) SCH# <br />® ADDENDUM TO (Identify environmental document) <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 I In the date for each document c ec e <br />A. REQUIRED WITH ALL APPLICATION SUBMITTALS: <br />® RFVJTD Revised pages attached <br />® LOCATION MAP Revised pages attached <br />® MITIGATION MONITORING & REPORTING PROGRAM <br />LIST OF PUBLIC HEARINGS AND OTHER MEETINGS OPEN TO THE PUBLIC <br />SCH# <br />® ENVIRONMENTAL DOCUMENT(S): <br />*EIR 90020924 <br />Previously submitted 0 MND/ND <br />0 EXEMPTION <br />0 ADDENDUM <br />B. ADDITIONAL REQUIRED DOCUMENTS FOR DISPOSAL FAC LONLY <br />❑ OPERATING LIABILITY FINANCIAL MECHANISM ® FINANCIAL RESPONSIBILITY DOCUMENTATION <br />® CLOSURE/POST CLOSURE MAINTENANCE PLAN O KNOWN OR REASONABLY FORSEEABLE CORRECTIVE ACTION COST ESTIMATES <br />0 PRELIMINARY <br />0 FINAL <br />❑ LANDFILL CAPACITY SURVEY RESULTS (see instructi <br />C. IF APPLICABLE: <br />REPORT OF WASTE DISCHARGE <br />Q <br />DEPT. OF TOXIC SUBSTANCES CONTROL OR CERTIFIED UNIFIED <br />PROGRAM AGENCY PERMIT <br />NPDES PERMIT APPLICATION <br />WETLANDS PERMITS <br />U I HtK <br />Q <br />VERIFICA I ION OF I•IRE UIS I RIC I COMPLIANCE <br />9 or disnosal site <br />Iif operator is dwfferent from land <br />ownerattarlease or of er agreement <br />TYPE OF BUSINESS: <br />® SOLE PROPRIETORSHIP ❑ PARTNERSHIP Xl CORPORATION ❑ GOVERNMENT AGENCY <br />OWNER(S) OF LAND ISSN OR TAX ID # <br />(Na USA Waste of California Inc. dba Central Valley Waste Services 66-0306154 <br />ADDRESS, CITY, STATE, ZIP <br />1333 East Turner Road, P.O. Box 241001, Lodi, CA 95241 <br />IE -MAIL ADDRESS: <br />gpineda@wm.com <br />Gilbert Pineda <br />Page 3 <br />