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Am <br /> In <br /> 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 /> ®ENVIRONMENTAL IMPACT REPORT(EIR)SCH# 90020924 <br /> ®NEGATIVE DECLARATION(ND)/MITIGATED NEGATIVE DECLARATION(MND)SCH# <br /> F-JADDENDUM 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: All documentation previously submitted. <br /> ®RFI/JTD May-02 x❑ENVIRONMENTAL DOCUMENT(S): <br /> ®LOCAL USE/PLANNING PERMITS Use Permit U 91-15(cover letter O NOD dated 7/23/91; filed 7/24/91; included <br /> oalea 572579 1)IRM001177PR <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 OFINANCIAL RESPONSIBILITY DOCUMENTATION <br /> ®CLOSURE/POST CLOSURE MAINTENANCE PLAN MLANDFILL CAPACITY SURVEY RESULTS(see instructions) <br /> ❑ PRELIMINARY <br /> ❑ FINAL <br /> C. IF APPLICABLE: <br /> ®REPORT OF WASTE DISCHARGE N/A DEPT.OF HEALTH SERVICES PERMIT N/A <br /> ®CONTRACT AGREEMENTS N/A aSWAT(Air and water) N/A <br /> ®STORMWATER PERMIT APPLICATION NUI Inciucleci In I HK ®WETLANDS PERMITS N/A <br /> ®NPDES PERMIT APPLICATION NIA VERIFICATION OF FIRE DISTRICT COMPLIANCE N/A <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 FLICORPORATION FGOVERNMENTAGENCY <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 /> ttoddOmm.com <br /> CONTACT PERSON(Print Name): <br /> jTroX Todd, District rla er <br /> Page 3 <br />