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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# N/A <br />NEGATIVE DECLARATION (ND)/MITIGATED NEGATIVE DECLARATION (MND) SCH# N/A <br />nADDENDUM TO (Identify environmental document) N.1 A SCH# N/A <br />B. IF ENVIRONMENTAL DOCUMENT(S) WAS NOT PREPARED, PLEASE PROVIDE THE FOLLOWING INFORMATION: <br />aCATEGORICAUSTATUTORY EXEMPT(CE/SE) <br />EXEMPTION TYPE NN GUIDELINE# N/A <br />Part 6. LIST OF ATTACHMENTS (Fill in the date for each document checked) <br />A. REQUIRED WITH ALL APPLICATION SUBMITTALS: <br />RFI/JTD <br />F-JLOCAL USE/PLANNING PERMITS <br />❑LOCATION MAP <br />MITIGATION MONITORING IMPLEMENTATION SCHEDULE <br />B. ADDITIONAL REQUIRED DOCUMENTS FOR LANDFILLS ONLY: <br />r-JOPERATING LIABILITY FINANCIAL MECHANISM <br />r--jCLOSURE/POST CLOSURE MAINTENANCE PLAN <br />❑ PRELIMINARY <br />❑ FINAL <br />C. IF APPLICABLE: <br />❑REPORT OF WASTE DISCHARGE " <br />❑CONTRACT AGREEMENTS " <br />❑STORMWATER PERMIT APPLICATION <br />aNPDES PERMIT APPLICATION <br />aOTHER <br />ENVIRONMENTAL DOCUMENT(S): <br />❑ EIR <br />❑ MND/ND <br />❑ EXEMPTION <br />❑ ADDENDUM <br />FINANCIAL RESPONSIBILITY DOCUMENTATION <br />LANDFILL CAPACITY SURVEY RESULTS (see instructions) <br />DEPT. OF HEALTH SERVICES PERMIT <br />SWAT (Air and water) <br />F�JWETLANDS PERMITS. <br />VERIFICATION OF FIRE DISTRICT COMPLIANCE <br />Pati 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 <br />®GOVERNMENT AGENCY <br />OWNER(S) OF LAND <br />SSN OR TAX ID # <br />(Name): San Joaquin County <br />Department of Public Works, Solid Waste Division <br />6800-14563 <br />ADDRESS, CITY, STATE, ZIP <br />TELEPHONE #: <br />Post Office Box 1810 <br />209-468-3066 <br />Stockton, California 95201 <br />FAX#: <br />209-468-3078 <br />E-MAIL ADDRESS: <br />Dreno@sjgov.org <br />CONTACT PERSON (Print Name): <br />Desi Reno <br />Page 3 <br />