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f Part 5. COMPLIANCE WITH CALIFORNIA EWRONMENTAL QUALITY ACT (Cl (Che plicable 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# 2006062113 <br />NEGATIVE DECLARATION (ND)/MITIGATED NEGATIVE DECLARATION (MND) SCH# <br />ADDENDUM TO (Identify environmental document) SCH# <br />B. IF ENVIRONMENTAL DOCUMENT(S) WAS NOT PREPARED, PLEASE PROVIDE THE FOLLOWING INFORMATION: EIR was prepared <br />FICATEGORICAUSTATUTORY 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: ®ENVIRONMENTAL DOCUMENT(S): <br />®RFI/JTD 9 -Sep -08 ®❑ EIR <br />LOCAL USE/PLANNING PERMITS NA/ (public agency) March 1989, SCH #88060714 (for initial siting) <br />December 2006, SCH #2006062113 (for permit revision) <br />®LOCATION MAP ❑ MND/ND NA <br />®MITIGATION MONITORING IMPLEMENTATION SCHEDULE ❑ EXEMPTION NA <br />Screening vegetation must be planted within one year of approval of this project <br />❑ ADDENDUM NA <br />B. ADDITIONAL REQUIRED DOCUMENTS FOR LANDFILLS ONLY: <br />®OPERATING LIABILITY FINANCIAL MECHANISM_ Self -Insurance FINANCIAL RESPONSIBILITY DOCUMENTATION <br />MX CLOSURE/POST CLOSURE MAINTENANCE PLAN (in JTD) ®LANDFILL CAPACITY SURVEY RESULTS (see instructions) <br />®❑ PRELIMINARY 24 -Jul -08 Attached - <br />❑ FINAL <br />";G.. IF APPLICABLE:.: <br />iREPORT OF WASTE DISCHARGE DEPT. OF HEALTH SERVICES PERMIT <br />❑CONTRACT AGREEMENTSSWAT (Air and water) <br />'j.--'STORMWATER PERMIT APPLICATION ❑ WETLANDS PERMITS <br />;.❑NPDES PERMIT APPLICATION FIVERIFICATION OF FIRE DISTRICT COMPLIANCE <br />MOTHER <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 County of San Joaquin SSN OR TAX ID # <br />(Name): <br />County of San Joaquil <br />ADDRESS, CITY, STATE, ZIP <br />Department of Public Works <br />Attention Solid Waste Division <br />PO Boz 1810, Stockton CA 95201 <br />NA <br />209-468-3066 (Solid Waste <br />209-468-3078 (Solid Waste Division <br />E-MAIL ADDRESS: <br />mcarroll@sjgov.org <br />(Print Name): <br />W. Michael Carroll <br />Page 3 <br />