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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 PREPARED FOR THIS PROJECT AND PROVIDE THE STATE CLEARINGHOUSE NUMBER(SCH#): <br /> ENVIRONMENTAL IMPACT REPORT(EIR)SC <br /> NEGATIVE DECLARATION(ND)/MITIGATED NEGATIVE DECLARATION(MND)SCH# 95-01 ND-75100 (3/29/1995) <br /> ADDENDUM TO(Identify environmental documi 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 /> ®RF#JTD JTD(July 30,2010) ENVIRONMENTAL DOCUMENT(S): <br /> ®LOCAL USE/PLANNING PERMITS UP#3295&UP#3451 ❑EIR <br /> �X LOCATION MAP See Revised JTD Figure 1 ❑MND/ND <br /> MITIGATION MONITORING IMPLEMENTATION SCHEDULE ❑EXEMPTION <br /> ❑ADDENDUM <br /> B.ADDITIONAL REQUIRED DOCUMENTS FOR LANDFILLS ONLY: <br /> ®OPERATING LIABILITY FINANCIAL MECHANISM Insurance Policy X FINANCIAL RESPONSIBILITY DOCUMENTATION Closure:Closure Enterprise Fund <br /> Postclosure:Pleadge of Future Revenue Agreement <br /> ®CLOSURE/POST CLOSURE MAINTENANCE PLAN ®LANDFILL CAPACITY SURVEY RESULTS(see instructions) See Revised JTD Table 3 <br /> X PRELIMINARY Revised July 30,2010 <br /> ❑ FINAL <br /> C. IF APPLICABLE: <br /> ®REPORT OF WASTE DISCHARGE W DR#R5-2003-0020 DEPT.OF HEALTH SERVICES PERMIT <br /> SWRCB Adopted January 2003 <br /> ®CONTRACT AGREEMENTS Operational Contract with Foothill Inc SWAT(Air and water) <br /> ®STORMWATER PERMIT APPLICATION WDID#55391005576 WETLANDS PERMITS <br /> (SW RCB) <br /> �NPDES PERMIT APPLICATIONVERIFICATION OF FIRE DISTRICT COMPLIANCE <br /> Linden Peters Fire District <br /> ®OTHER San Joaquin Valley APCD Permit#N-4070 Permit#09-021 <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 /> SOLE PROPRIETORSHIP PARTNERSHIP CORPORATION GOVERNMENTAGENCY <br /> OWNER(S)OF LAND SSN OR TAX to# <br /> (Name): 94-6000-531 <br /> San Joaquin County,Department o/Public Works,Solid Waste Div <br /> ADDRESS,CITY,STATE,ZIP TELEPHONE#: <br /> 209 468-3066 <br /> FAX#: <br /> 209 468-3078 <br /> PO Box 1810,Stockton,CA 95201 E-MAIL ADDRESS: <br /> mcarroll s' ov.or <br /> CONTACT PERSON(Print Name): <br /> Senior Civil Engineer W.Michael Carroll <br /> N:\1 Foothill\JTD-Permit Review 2010\ <br /> FH-5 yr_Permit Review App n Tables.xls 3 of 4 <br />