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Part 6.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 /> ®ENVIRONMENTAL IMPACT REPORT(EIR)SCH# <br /> ®NEGATIVE DECLARATION(ND)IMITIGATED NEGATIVE DECLARATION(MND)SCH# <br /> ®ADDENDUM TO(IdeMily environmental document) SCH# <br /> B. IF ENVIRONMENTAL DOCUMENT(S)WAS NOT PREPARED,PLEASE PROVIDE THE FOLLOWING INFORMATION: <br /> ®CATEGORICAL/STATUTORY 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 Revised TPR pages ®ENVIRONMENTAL DOCUMENT(S): <br /> ❑LOCAL USEIPLANNING PERMITS ❑EIR <br /> ®LOCATION MAP ❑MND/ND <br /> ®MITIGATION MONITORING IMPLEMENTATION SCHEDULE ❑EXEMPTION <br /> ❑ADDENDUM <br /> B. ADDITIONAL REQUIRED DOCUMENTS FOR LANDFILLS ONLY: <br /> ®OPERATING LIABILITY FINANCIAL MECHANISM FINANCIAL RESPONSIBILITY DOCUMENTATION <br /> ®CLOSURE/POST CLOSURE MAINTENANCE PLAN LANDFILL CAPACITY SURVEY RESULTS(see instructions) <br /> ❑ PRELIMINARY <br /> ❑ FINAL <br /> C. IF APPLICABLE: <br /> ®REPORT OF WASTE DISCHARGE DEPT.OF HEALTH SERVICES PERMIT <br /> ®CONTRACT AGREEMENTS SWAT(Air and water) <br /> ®STORMWATER PERMIT APPLICATION WETLANDS PERMITS <br /> ®NPDES PERMIT APPLICATION VERIFICATION OF FIRE DISTRICT COMPLIANCE <br /> ®OTHER <br /> Part 7.OWNER INFORMATION (For disposal site,if operator is different from landowner,attach lease or other agreement) <br /> TYPE OF BUSINESS: <br /> []Sol E PROPRIETORSHIP ®PARTNERSHIP x CORPORATION ®GOVERNMENT AGENCY <br /> OWNER(S)OF LAND SSN OR TAX ID# <br /> (Name): <br /> USA WASTE OF CALIFORNIA dba Central Valley Waste Services 68-0306154 <br /> ADDRESS,CITY,STATE,ZIP TELEPHONE#: <br /> P.O.Box 241001,1333 East Turner Road,Lodi,California 95241-9501 209-333-5611 <br /> FAX#: <br /> 209-369-6894 <br /> E-MAIL ADDRESS: <br /> pfenton Wm.com <br /> CONTACT PERSON(Print Name): <br /> Patrick Fenton, District Manager <br /> Page 3 <br />