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0 <br /> 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 /> ENVIRONMENTAL IMPACT REPORT(EIR)SC <br /> �X NEGATIVE DECLARATION(ND)/MITIGATED NEGATIVE DECLARATION(MND)SCH# 95012059(March 29,1995) <br /> ADDENDUM TO(Identify environmental documn SCH# <br /> B. IF ENVIRONMENTAL DOCUMENT(S)WAS NOT PREPARED,PLEASE PROVIDE THE FOLLOWING INFORMATION: <br /> CATEGORICAL/STATUTORY 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 /> ®RFt/JTD JTD(July 30,2010) ENVIRONMENTAL DOCUMENT(S): <br /> LOCAL USE/PLANNING PERMITS ❑EIR <br /> LOCATION MAP ❑MND/ND <br /> MITIGATION MONITORING IMPLEMENTATION SCHEDULE ❑EXEMPTION <br /> ❑ADDENDUM <br /> B.ADDITIONAL REQUIRED DOCUMENTS FOR LANDFILLS ONLY: <br /> OPERATING LIABILITY FINANCIAL MECHANISM ®FINANCIAL RESPONSIBILITY DOCUMENTATION <br /> CLOSURE/POST CLOSURE MAINTENANCE PLAN LANDFILL CAPACITY SURVEY RESULTS(see instructions) 6/10/2010 <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 /> O STORMWATER PERMIT APPLICATION WETLANDS PERMITS <br /> �NPDES PERMIT APPLICATION VERIFICATION OF FIRE DISTRICT COMPLIANCE <br /> OTHER <br /> Part 7.OWNER INFORMATION (For disposal site,if operator is different from landowner,attach lease or other agreement) <br /> TYPE OF BUSINESS: <br /> SOLE PROPRIETORSHIP PARTNERSHIP CORPORATION GOVERNMENT AGENCY <br /> OWNER(S)OF LAND SSN OR TAX to# - <br /> (Name): <br /> San Joaquin County,Department of Public Works,Solid Waste Div <br /> ADDRESS,CITY,STATE,ZIP TELEPHONE#: <br /> 209-468-3066 <br /> FAX M <br /> 209-468-3078 <br /> PO Box 1810,Stockton,CA 95201 E-MAIL ADDRESS: <br /> mcarrolls' ov.or <br /> CONTACT PERSON(Print Name): <br /> Senior Civil En ineer W.Michael Carroll <br /> N:\1 Foothill\JTD-Permit Review 2010\FH-JTD-Tables 1-4.xis,CIWMB177 <br />