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Part 5.COMPLIANCE WITH CAL 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 /> FE ENVIRONMENTAL IMPACT REPORT(EIR)SCH# 9209072 February 1994 <br /> ONEGATIVE DECLARATION(ND)/MITIGATED NEGATIVE DECLARATION(MND)SCH# <br /> ®ADDENDUM TO(Identify environmental document) SCH# <br /> B. IF ENVIRONMENTAL DOCUMENT(S)WAS NOT PREPARED,PLEASE PROVIDE THE FOLLOWING INFORMATION: <br /> ®CATEGORICAUSTATUTORY 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 /> ®RFI/JTD TPR dated April,2010 X❑ENVIRONMENTAL DOCUMENT(S): <br /> FILOCAL USE/PLANNING PERMITS UP-93-2(Oct 1993) o EIR SCH#9209072 February 1994 <br /> ®LOCATION MAP See TPR o MND/ND <br /> FiDMITIGATION MONITORING IMPLEMENTATION SCHEDULE 6-Jul-93 o EXEMPTION <br /> ❑ADDENDUM <br /> B. ADDITIONAL REQUIRED DOCUMENTS FOR LANDFILLS ONLY: NA-Not a landfill <br /> ®OPERATING LIABILITY FINANCIAL MECHANISM FINANCIAL RESPONSIBILITY DOCUMENTATION <br /> ❑CLOSURE/POST CLOSURE MAINTENANCE PLAN DLANDFILL CAPACITY SURVEY RESULTS(see instructions) <br /> ❑ PRELIMINARY <br /> ❑ FINAL <br /> C. IF APPLICABLE: <br /> ®REPORT OF WASTE DISCHARGE NA ®DEPT.OF HEALTH SERVICES PERMIT <br /> ®CONTRACT AGREEMENTS ®SWAT(Air and water) <br /> 0STORMWATER PERMIT APPLICATION ❑WETLANDS PERMITS <br /> F1NPDES 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 DCORPORATION EIGOVERNMENT AGENCY <br /> OWNER(S)OF LAND SSN OR TAX ID# <br /> (Name): <br /> San Joaquin County Department of Public Works Solid Waste Division 6800-14563 <br /> ADDRESS,CITY,STATE,ZIP TELEPHONE#: <br /> PO Box 1810,Stockton CA 95201 209-468-3066 <br /> FAX#: <br /> 209-468-3078 <br /> E-MAIL ADDRESS: <br /> tbahadori _sigov.org <br /> CONTACT PERSON(Print Name): <br /> Ta'Bahadori <br /> Lovelace Permit Review 2015 Printed 2/23/2015 Q->_0f`�' <br />