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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 /> QENVIRONMENTAL IMPACT REPORT(EIR)SCH# <br /> aX NEGATIVE DECLARATION(ND)/MITIGATED NEGATIVE DECLARATION(MND)SCH# 2010112045 <br /> ADDENDUM TO(Identify environmental document) SCH# <br /> B. IF ENVIRONMENTAL DOCUMENT(S)WAS NOT PREPARED,PLEASE PROVIDE THE FOLLOWING INFORMATION: <br /> F--JCATEGORICAUSTATUTORY EXEMPTION(CE/SE) <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 /> Fx RFI/JTD Existing JTD(Amended 2008)(currently on file with LEA) ®ENVIRONMENTAL DOCUMENT(S): <br /> ❑X LOCAL USE/PLANNING PERMITS April 2003 ❑EIR <br /> FX LOCATION MAP Stage 1 B Partial Final Closure/Post-Closure Maintenance Plan(June 2011)-Figure 1 X MND/ND SCH#2010112045 <br /> QX MITIGATION MONITORING IMPLEMENTATION SCHEDULE December 2002 ❑EXEMPTION <br /> ❑ADDENDUM <br /> B. ADDITIONAL REQUIRED DOCUMENTS FOR LANDFILLS ONLY: <br /> FX OPERATING LIABILITY FINANCIAL MECHANISM: May 2008 FX FINANCIAL RESPONSIBILITY DOCUMENTATION February 2006 <br /> FX CLOSURE/POST CLOSURE MAINTENANCE PLAN ❑X LANDFILL CAPACITY SURVEY RESULTS(see instructions): March 2011 <br /> X PRELIMINARY In Appendix L of JTD(Amended 2008)(currently on file with LEA) <br /> ❑ FINAL <br /> C. IF APPLICABLE: <br /> ❑REPORT OF WASTE DISCHARGE FjDEPT.OF HEALTH SERVICES PERMIT <br /> F—ICONTRACT AGREEMENTS SWAT(Air and water) <br /> ®STORMWATER PERMIT APPLICATION WETLANDS PERMITS <br /> E-1NPDES PERMIT APPLICATION ❑VERIFICATION OF FIRE DISTRICT COMPLIANCE <br /> OTHER <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 177_ CORPORATIONGOVERNMENT AGENCY <br /> OWNER(S)OF LAND SSN OR TAX ID# <br /> (Name): <br /> Forward, Inc. 941544481 <br /> ADDRESS,CITY,STATE,ZIP TELEPHONE#: <br /> 209.982.4298 <br /> FAX#: <br /> 209.982.1009 <br /> 9999 S. Austin Road, Manteca, CA 95336 E-MAIL ADDRESS: <br /> dlitchfieldCc)reDublicservices.com <br /> CONTACT PERSON(Print Name): <br /> Don Litchfield <br /> Page 3 <br />