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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 PREPA,=D FOR THIS PROJECT AND PROVIDE THE STATE CLEARINGHOUSE NUMBER(SCH#): <br /> DENVIRONMENTAL IMPACT REPORT(EIR)SOI <br /> NEGATIVE DECLARATION(NOYMITiGATED NEGATIVE DECLARATION(MND)SCH# 95012059(March 29,1995) <br /> ADDENDUM TO(Identity emironmental docume SCH# <br /> B. IF ENVIRONMENTAL DOCUMENT(S)WAS NOT PREPARED,PLEASE PROVICE THE FOLLOWING INFORMATION: <br /> CATEGORICAUSTATUTORY EXEMPTION(CE SE) <br /> EXEMPTION T' GUIDELINE# <br /> Part 6.LIST OF ATTACHMENTS(Fill in the date for each document checked) <br /> A.REQUIRED WITH ALL APPLICATION SUBMITTALS: <br /> ®RFI/JTD JTO(August 15,2005) ENVIRONMENTAL DOCUMENT(S): <br /> LOCAL USE/PLANNING PERMITS 0 EIR <br /> LOCATION MAP ❑MND/NO <br /> MITIGATION MONITORING IMPLEMENTATION SCHEDULE ❑EXEMPTION <br /> 0 ADDENDUM <br /> B. ADDITIONAL REQUIRED DOCUMENTS FOR LANDFILLS ONLY: <br /> ®OPERATING LIABILITY FINANCIAL MECHANISM 5/26/2005 O FINANCIAL RESPONSIBILITY DOCUMENTATION 4/28/2005 <br /> ®CLOSURE/POST CLOSURE MAINTENANCE PLAN Feb-05 ®LANDFILL CAPACITY SURVEY RESULTS(see irstniciions) 10/24/2004 <br /> X 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 /> �STORMWATER PERMIT APPLICATION OWETLANDS PERMITS <br /> �NPDES PERMIT APPLICATION VERIFICATION OF FIRE DISTRICT COMPLIANCE <br /> OOTHER <br /> Part 7.OWNER INFORMATION (For disposal site,it operator is different from land owner,attach lease or other agreement) <br /> TYPE OF BUSINESS: <br /> SOLE PROPRIETORSHIP PARTNERSHIP CORPORATION GOVERNMENT AGENCY <br /> OW NER(S)OF LAND SSN OR TAX ID# <br /> (Name): <br /> Son Joagukt County,Deport"nt of Pubhc Works Sold Wade DN <br /> ADORES&CITY,STATE ZIP TELEPHONE#: <br /> 229.4683006 <br /> FAX#: <br /> 209-4683078 <br /> PO Box 1810,Stockton,CA 95201 E-MAIL ADDRESS: <br /> CONTACT PERSON(Print Nome): <br /> Senior Civil En ineer W.Michael Carroll <br /> N:\1 FoothilNTD-2004\5-year permit app July 05\ApplForSW-FacilityPermit-FH.xls,Sheetl <br />