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Nature of Activity(Descripbon of project,include aH f �+s) 1 �e supplemental information sheet Project Purpose(Describe the reason or purpose of the project, see instrucSons) .e supplemental information sheet USE BLACKS 20-22 IF DREDGED AND/OR FILL MATERIAL IS TO BE DISCHARGED Reason(s)for Discharge ie stream channel would be filled to create a stable surface over which landfill materials )uld be placed. Type(s)of Material Being Discharged and the Amount of Each Type in Cubic Yards )cally excavated native soil, approximately 84,040 cubic yards . Surface Area in Acres of Wetlands or Other Waters Filled(see instruc6ons) .895 acres of waters of the United States, including 0.86 acre of wetlands Is Any Portion of the Work Already Complete? YES No _ XX_ IF YES, DESCRIBE THE COMPLETED WORK Addresses of Adjoining Property Owners, Lessees, Etc.,Whose Property Adjoins the Waterbody(if more than can be entered here, please attach a pplementa€list) �+.1 ae attached supplemental list List of Other Certifications or Approvals/Denials Received from other Federal,State or Local Agencies for Work Described in This Application AGENCY TYPE APPROVAL IDENTIFICATION NUMBER DATE APPLIED DATE APPROVED DATE DENIED :ockton City Council, Final EIR, SCH No. 90020718, certified September 6, 1994 )FG Section 1601 Streambed Alteration Agreement, application to be filed eclamation Board Encroachment Permit, applied September 16, 1994 egional Water Quality Control Board Section 401 Certification, applied October 9, 1995 ilifornia integrated Waste Management Board Solid Waste Facilities permit, application to be filed aderal Aviation Administration Notice of Proposed Construction or Alteration, filed Jould include but is not restricted to zoning,building and flood plain permits. Application is hereby made for a permit or permits to authorize the work described in this application. I ce hat the information in this application is complete and accurate. I further certify that I possess the authority to undertake the work de n her in m.a as ed agent of the applicant. SIGNATURE OF APPLICANT DATE f D#TE The application must be signed by the person who desires to undertake the proposed acti ty(applicant)or it may be signed by a duty authorized agent if the statement in block 11 has been filled out and signed. 18 U.S.C.Section 1001 provides that:Whoever,in any manner within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies conceals,or covers up any trick,scheme,or disguises a material fact or makes any false,fictitious or fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false,fictitious or fraudulent statements or entry,shall be fined not more than$10,000 or imprisoned not more than five years or both. •U.S.GPOA 994-5e0-47&62018