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fJb <br /> Part S.COMPLIANCE WITH CALIFORNIA ENICONMENTAL QUALFFY ACT(CEEk)(Check a p' ble 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 /> El ENVIRONMENTAL IMPACT REPORT(EIR)SCH# <br /> NEGATIVE DECLARATION(ND)/MITIGATED NEGATIVE DECLARATION(MND)SCH# " J®®O a V <br /> ADDENDUM TO(Ide"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 /> rLtahiRFUJTD �` ' '�7(^' ux A:qfh Il 19 91 ENVIRONMENTAL DOCUMENT(S): <br /> LOCAL USEIPLANNING PERMITS S CJ c t.2d 043 ❑EIR <br /> LOCATION MAP y MNDIND LA <br /> MrrIGATION MONITORING IMPLEMENTATION SCHEDULE O EXEMPTION <br /> ❑ADDENDUM <br /> B. ADDITIONAL REQUIRED DOCUMENTS FOR LANDFILLS ONLY: <br /> OPERATING LIABILITY FINANCIAL MECHANISM FINANCIAL RESPONSIBILITY DOCUMENTATION <br /> CLOSUREROST CLOSURE MAINTENANCE PLAN LANDFILL CAPACITY SURVEY RESULTS(see instructions) <br /> 10 PRELIMINARY <br /> 0 FINAL <br /> C. IFAPPLICABLE: ®CJ <br /> REPORT OF WASTE DISCHARGE r�`VC�( DEPT.OF HEALTH SERVICES PERMIT <br /> CONTRACT AGREEMENTS C SWAT(Air wW water) <br /> STORMWATER PERMIT APPLICATION WETLANDS PERMITS q <br /> NPDES PERMIT APPLICATION VERIFICATION OF FIRE DISTRICT COMPLIANCE �Ay y® N c E✓5 <br /> OTHER ��rc �1Sri`� ® t`l <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 CORPORATION GOVERNMENT AGENCY <br /> OWNER(S)OF LAND SSN OR TAX ID# G C <br /> (Name): —6 1� Q <br /> ®° �� 1 J I t <br /> kAAPo o1Ei. 0c ID nhTtonl <br /> ADDRESS,CITY,STATE,ZIP TELEPHONE#: <br /> ®q t3 tis <br /> FAX#: <br /> E-MAIL ADDRESS: <br /> ray SouvZa^(b) 5`Aks .(,Dm <br /> CONTACT PERSON(Print Name): p <br /> V ov {e)a ®° <br /> Page 3 <br />