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10. AdlllllhA1111116 <br />. <br />Part 5. COMPLIANCE WITH CALIFORNIA ENVMbNMENTAL QUALITY ACT (CEQA) (Check aRKcable 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 />FIENVIRONMENTAL IMPACT REPORT (EIR) SCH# SCH#93042093 <br />NEGATIVE DECLARATION (ND)/MITIGATED NEGATIVE DECLARATION (MND) SCH# <br />ADDENDUM TO (Identify environmental document) <br />B. IF ENVIRONMENTAL DOCUMENT(S) WAS NOT PREPARED, PLEASE PROVIDE THE FOLLOWING INFORMATION: <br />SCH#96102011 <br />SCH# <br />X�CATEGORICAL/STATUTORY EXEMPTION (CE/SE) <br />EXEMPTION TYPE Categorical Exemption GUIDELINE # Existing Facility - Section 15301 - Class 1 (a) <br />Part 6. LIST OF ATTACHMENTS (Fill in the date for each document checked) <br />A. REQUIRED WITH ALL APPLICATION SUBMITTALS: <br />Fx-]RFI/JTD 12/93, Amendments to RFI 09/96, 12/04, 03/ <br />IX (LOCAL USE/PLANNING PERMITS UP -93-41 <br />X❑LOCATION MAP Figures, RFI Amendment 03/06 <br />MITIGATION MONITORING IMPLEMENTATION SCHEDULE <br />B. ADDITIONAL REQUIRED DOCUMENTS FOR LANDFILLS ONLY: <br />F-JOPERATING LIABILITY FINANCIAL MECHANISM_ n/a <br />CLOSURE/POST CLOSURE MAINTENANCE PLAN n/a <br />❑ PRELIMINARY <br />❑ FINAL <br />C. IF APPLICABLE: <br />XIREPORT OF WASTE DISCHARGE <br />F-�CONTRACT AGREEMENTS <br />F-1STORMWATER PERMIT APPLICATION <br />FINPDES PERMIT APPLICATION <br />Waiver. 3194 <br />k]OTHER APCD Permit to Construct #N-3187-4-0 <br />X❑ ENVIRONMENTAL DOCUMENT(S): <br />X EIR SCH#93042093 <br />❑ MND/ND SCH# 96102011 <br />❑ EXEMPTION <br />❑ ADDENDUM <br />7FINANCIAL RESPONSIBILITY DOCUMENTATION <br />n/a <br />LANDFILL CAPACITY SURVEY RESULTS (see instructions) n/a <br />DEPT. OF HEALTH SERVICES PERMIT <br />SWAT (Air and water) <br />WETLANDS PERMITS <br />VERIFICATION OF FIRE DISTRICT COMPLIANCE <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 />1:1 SOLE PROPRIETORSHIP PARTNERSHIP ElCORPORATION �GOVERNMENTAGENCY <br />OWNER(S) OF LAND SSN OR TAX ID # <br />(Name): <br />Mike Re etto #680293953 <br />ADDRESS, CITY, STATE, ZIP TELEPHONE #: <br />Tracy Material Recovery and Transfer Facility (209)835-0601 <br />60 E. 11th Street, Tracy CA 95376 <br />FAX #: <br />(209)835-7729 <br />E-MAIL ADDRESS: <br />miker@tdswm.com <br />CONTACT PERSON (Print Name): <br />Mike Repetto <br />Page 3 <br />