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A. CHECK BOX(ES) IF ENVIRONMENTAL DOCUMENT WAS OR WILL BE PREPARED FOR THIS PROJECT: <br />XX 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 />CATEGORICAUSTATUTORY EXEMPTION (CE/SE) <br />EXEMPTION TYPE GUIDELINE # <br />Pail I In t o Me or eacR aocumente <br />A. REQUIRED WITH ALL APPLICATION SUBMITTALS: <br />® RFI/JTD Revised pages attached <br />® LOCATION MAP Revised pages attached <br />® MITIGATION MONITORING & REPORTING PROGRAM <br />SCH# <br />® ENVIRONMENTAL DOCUMENT(S): <br />SEIR 90020924 <br />Previously submitted ❑ MND/ND <br />® LIST OF PUBLIC HEARINGS AND OTHER MEETINGS OPEN TO THE PUBLIC ❑ EXEMPTION <br />❑ PRELIMINARY <br />❑ FINAL <br />C. IF APPLICABLE: <br />Q REPORT OF WASTE DISCHARGE <br />0 <br />ElLANDFILL CAPACITY SURVEY RESULTS (see instructs <br />DEPT. OF TOXIC SUBSTANCES CONTROL OR CERTIFIED UNIFIED <br />PROGRAM AGENCY PERMIT <br />NPDES PERMIT APPLICATION M WETLANDS PERMITS <br />xl OTHER Facility Use Permit U91-15, June 1991 ❑ VERIFICATION OF FIRE DISTRICT COMPLIANCE <br />9 (For disnosal site if operator IS diffPrant from land ownpr attach lease or athPr anrppment) <br />TYPE OF BUSINESS: <br />11 SOLE PROPRIETORSHIP ❑ PARTNERSHIP XI CORPORATION ❑ GOVERNMENT AGENCY <br />OWNER(S) OF LAND SSN OR TAX ID # <br />(Name): USA Waste of California Inc. dba Central Valley Waste Services 68-0306154 <br />ADDRESS, CITY, STATE, ZIP <br />1333 East Turner Road, P.O. Box 241001, Lodi, CA 95241 <br />a <br />Gilbert Pineda <br />gl2ineda@wm.com <br />Page 3 <br />❑ ADDENDUM <br />B. ADDITIONAL REQUIRED DOCUMENTS FOR DISPOSAL FACILITIES <br />❑ OPERATING LIABILITY FINANCIAL MECHANISM <br />ONLY: <br />❑ FINANCIAL RESPONSIBILITY DOCUMENTATION <br />CLOSURE/POST CLOSURE MAINTENANCE PLAN <br />11 KNOWN OR REASONABLY FORSEEABLE CORRECTIVE ACTION COST ESTIMATES <br />❑ PRELIMINARY <br />❑ FINAL <br />C. IF APPLICABLE: <br />Q REPORT OF WASTE DISCHARGE <br />0 <br />ElLANDFILL CAPACITY SURVEY RESULTS (see instructs <br />DEPT. OF TOXIC SUBSTANCES CONTROL OR CERTIFIED UNIFIED <br />PROGRAM AGENCY PERMIT <br />NPDES PERMIT APPLICATION M WETLANDS PERMITS <br />xl OTHER Facility Use Permit U91-15, June 1991 ❑ VERIFICATION OF FIRE DISTRICT COMPLIANCE <br />9 (For disnosal site if operator IS diffPrant from land ownpr attach lease or athPr anrppment) <br />TYPE OF BUSINESS: <br />11 SOLE PROPRIETORSHIP ❑ PARTNERSHIP XI CORPORATION ❑ GOVERNMENT AGENCY <br />OWNER(S) OF LAND SSN OR TAX ID # <br />(Name): USA Waste of California Inc. dba Central Valley Waste Services 68-0306154 <br />ADDRESS, CITY, STATE, ZIP <br />1333 East Turner Road, P.O. Box 241001, Lodi, CA 95241 <br />a <br />Gilbert Pineda <br />gl2ineda@wm.com <br />Page 3 <br />