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applicable boxes) <br /> P- 5.COMPLIANCE WITH CALIFORNIA ENVIRONMENTALFORTALITY H S PROJECT AND PROVIDE CT CTHE STATED CLEARINGHOUSE NUMBER(SCH#): <br /> ECK BOX(ES)IF ENVIRONMENTAL DOCUMENT WAS OR WILL BE PREPARED <br /> ®ENVIRONMENTAL IMPACT REPORT,,E'IRI BCH'; <br /> 0NEGATIVE DECLARATION(ND)IMITIGATED NEGATIVE DECLARATION(MND)BCH:: BCH# <br /> aADDENDUM TO(ldentibi za.,ronr.er= =car.en[`. <br /> B. IF ENVIRONMENTAL DOCUMENT(S)WAS NOT PREPARED.PLEASE PROVIDE THE FOLLOWING INFORMATION_ <br /> a <br /> CAT EGORICAL'STATUTCRY EXE%ip7 CN IC=-SEI GUDEL!NE <br /> EXEMPTION TYPE - <br /> Part 6.LIST OF ATTACHMENTS(Fill in the date for each document checked? <br /> A.REQUIRED WITH ALL APPLICATION SUBMITTALS: <br /> ENVIRONMENTAL DocuMENT(s): <br /> ®RFI/JTD Sept. 23, 1993 (partial revision 1/12/02) UXEIR June 1993 <br /> ©LOCAL USE(PLANNING PERMITS 0 C t. 20, 1993 n 1.110:Nc <br /> ®LOCATION MAP 7/6/93 ❑EXEMPTION <br /> ®MITIGATION MONITORING IMPLEMENTATION SCHEDULE ❑ADCEtiDUM <br /> B. ADDITIONAL REQUIRED DOCUMENTS FOR LANDFILLS ONLY- ❑F NAND M` Jar NS'L CCU'-IENTATION <br /> OPERATING LIABILITY FINANCIAL MECHAN S.'--_------ <br /> OLANDFILL CAPACITY SURVEY RESULTS(see instructions) <br /> CICLOSURE/POST CLOSURE MAINTENANCE PLAN <br /> ❑ PRELIMINARY <br /> ❑ FINAL <br /> C. IF APPLICABLE: DEPT.Gr HEALTH SERVICES PERMIT <br /> REPORT OF WASTE DISCHARGESWAT(Air anc water) <br /> CONTRACT AGREEMENTS OWETLANDS pERMITS <br /> 0STORMWATER PERMIT APPLICATION <br /> VERIFICATION OF FIRE DISTRICT COMPLIANCE <br /> DNPDES PERMIT APPLICATION <br /> OTHER <br /> part <br /> 7.OWNER INFORMATION (Fer dsposa s= `o-erator is ditterent from lard -r.attach lease or etcher agreement) <br /> B :� vv.^ERN <br /> MENT AGENCY <br /> .r..r_-.. V <br /> TYPE OF BUSINESS: _ _ �GCr <br /> ❑SOLE PROPRiET ORSH:P SSN OR TAX ID# <br /> OWNER(S)OF LAND <br /> (Name): 94-6000-531 <br /> San Joaquin County TELEPHONE#: <br /> ADDRESS.CITY.STATE,ZIP (209 468-3066 <br /> Department of Public G:orks <br /> FAX#. <br /> p. 0. Box 1810 <br /> Stockton, CA. 95201 (209 468_3078 <br /> E-MAIL ADDRESS: <br /> aborges@co.san-joaquin.ca.us <br /> CONTACT PERSON(Print Name): <br /> Annette Borges <br /> Page 3 <br />