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,Y <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 />—1 ENVIRONMENTAL IMPACT REPORT (EIR)SCH# SCH#93042093 <br />X�NEGATIVE DECLARATION (NDYMITIGATED NEGATIVE DECLARATION (MND) SCH# SCH#2011102013 <br />F-JADDENDUM TO (Identify environmental document) SCH# <br />B. IF ENVIRONMENTAL DOCUMENTS) WAS NOT PREPARED, PLEASE PROVIDE THE FOLLOWING INFORMATION: <br />MCATEGORICAusTATUTORY EXEMPTION (CENSE) <br />EXEMPTION TYPE GUIDELINE# <br />Part 6. LIST OF ATTACHMENTS (Fill in the date for each document checked) <br />A. REQUIRED WITH ALL APPLICATION SUBMITTALS: <br />lx-�RFVJTD .lune 2013X❑ ENVIRONMENTALDOCUMENT(S): <br />X❑LOCALUSEIPLANNINGPERMITS UP -93-41, PA -0800005 XEIR SCH#93042093 <br />El LOCATION MAP June 2013 x SCH#2011102013 <br />FIMITIGATION MONITORING IMPLEMENTATION SCHEDULE X Exemption NOE July 5, 20061' <br />❑ ADDENDUM <br />B. ADDITIONAL REQUIRED DOCUMENTS FOR LANDFILLS ONLY: <br />OPERATING LIABILITY FINANCIAL MECHANISM_ Na; ®FINANCIAL RESPONSIBILITY DOCUMENTATION n/a <br />F-ICLOSURE/POST CLOSURE MAINTENANCE PLAN n/a ®LANDFILL CAPACITY SURVEY RESULTS (see instructions) nta <br />❑ PRELIMINARY <br />❑ FINAL <br />C. IF APPLICABLE: <br />X❑REPORT OF WASTE DISCHARGE Waiver, 3194 ®DEPT. OF HEALTH SERVICES PERMIT <br />®CONTRACT AGREEMENTS ®SWAT (Air and water) <br />®STORMWATER PERMIT APPLICATION ®WETLANDS PERMITS <br />®NPDES PERMI I APPLICATION ®VERIFICATION OF FIRE DISTRICT COMPLIANCE <br />X❑OTHER APCD Permit to Construct #N-3187-4-0 <br />Part 7. OWNER INFORMATION (For disposal site, ff operator is different from landowner, attach lease or other agreement) <br />TYPE OF BUSINESS: <br />®SOLE PROPRIETORSHIP ®PARTNERSHIP I^ lCORPORATION ❑GOVERNMENT AGENCY <br />OWNER(S) OF LAND SSN OR TAX ID # <br />(Name): <br />Mike Re etto #680293953 <br />ADDRESS, CITY, STATE, ZIP TELEPHONE M. <br />Tracy Material Recovery & Transfer Facility (209)835-0601 <br />30703 S. MacArthur Drive Tracy CA 95376 <br />FAX P. <br />(209) 835- 7729 <br />E-MAIL ADDRESS: <br />Mike <br />Page 3 <br />