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• s <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# <br /> NEGATIVE DECLARATION(ND)/MITIGATED NEGATIVE DECLARATION(MND)SCH# Oa ay d <br /> F—JADDENDUM TO(Identify environmental document) SCH# <br /> B. IF ENVIRONMENTAL DOCUMENT(S)WAS NOT PREPARED,PLEASE PROVIDE THE FOLLOWING INFORMATION: <br /> F--lCATEGORICAL/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 /> MRFI/JTDr 1) Z ao I a (1 ®ENVIRONMENTAL DOCUMENT(S): <br /> I IV LOCAL USE/PLANNING PERMITS[ 1 rn f�f1 DC7 L 11EIR <br /> LOCATION MAP rnq r` 5r .� L�)"l MND/ND U I'� S I Q LDI 2 <br /> QMITIGATION MONITORING IMPLEMENTATION SCHEDULE �Q'Z�\`�, o�Q) Z ❑EXEMPTION <br /> `T' ❑ADDENDUM <br /> B. ADDITIONAL REQUIRED DOCUMENTS FOR LANDFILLS ONLY: <br /> F—JOPERATING 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: 09 <br /> REPORT OF WASTE DISCHARGE LLArr�z n'IL []DEPT.OF HEALTH SERVICES PERMIT <br /> E]CONTRACTAGREEMENTS m� [:]SWAT(Air and water) <br /> M STORM WATER PERMIT APPLICATION TV W" <br /> Lam/Ir <br /> ETLANDS PERMITS <br /> �NPDES PERMIT APPLICATION I7�yvERIFICATION OF FIRE DISTRICT COMPLIANCE Lam/ Y� CLl P <br /> MOTHER llt!31 T <br /> P -T d <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 /> 21SOLEPROPRIETORSHIP PARTNERSHIP CORPORATION EIGOVERNMENTAGENCY <br /> OWNER(S)OF LAND SSN OR TAX ID# <br /> (Name): <br /> O M-es �r z _ � <br /> ADDRESS,CITY,STATE,ZIP TELEPHONE#: <br /> Ln k-p C�6)v c- a <br /> FAX#: <br /> dn �dQ�Ie q ���1 <br /> aZ) <br /> E-MAIL ADDRESS: <br /> o L C z> <br /> CONTACT PERSON(Print ame): <br /> 7 <br /> Page 3 <br />