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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 /> ®ENVIRONMENTAL IMPACT REPORT(EIR)SCH# <br /> 10 NEGATIVE DECLARATION(ND)/MITIGATED NEGATIVE DECLARATION(MND)SCH# ®J 20 Z ® Z <br /> oADDENDUM 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 ENVIRONMENTAL DOCUMENT(S): <br /> LOCAL USE/PLANNING PERMITS m yr!� 1 g"�'Z® 1"2_ ❑EIR <br /> LLILOCATION MAP r' LU I 'Z, PND/ND i <br /> MITIGATION MONITORING IMPLEMENTATION SCHEDULE (YICr C)n I J 'ate ❑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: O—U) motif <br /> ® <br /> REPORT OF WASTE DISCHARGE DEPT.OF HEALTH SERVICES PERMIT <br /> ®CONTRACT AGREEMENTS ❑SWAT(Air and water) <br /> ®STORMWATERPERMIT APPLICATION ®WETLANDS PERMITS p� r <br /> E1NPDES PERMIT APPLICATIONP p VERIFICApTION OF FIRE DISTRICT COMPLIANCE tr m:a IVn e- <br /> OTHER f f 1 4 L 6 !1—3-1 <br /> l - 14 4LAI <br /> � 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# <br /> (Name): <br /> IA t 5 (,Kk <br /> ADDRESS,CITY,STATE,ZIP TELEPHONE#: <br /> FAX#: <br /> E-MAIL ADDRESS: <br /> �I• (� <br /> CONTACT PERSON(Print Name): <br /> S C - <br /> Page 3 <br />