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i 0 <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# 2001052081(dated 2002) <br /> NEGATIVE DECLARATION(ND)/MITIGATED NEGATIVE DECLARATION(MND) <br /> ®ADDENDUM TO(Identify environmental document): <br /> B. IF ENVIRONMENTAL DOCUMENT($)WAS NOT PREPARED,PLEASE PROVIDE THE FOLLOWING INFORMATION: <br /> MCATEGORICAL/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 /> MRFVJTD:Reoort of Comoostina Site Information(RCSI)(dated 2014): ®ENVIRONMENTAL DOCUMENT(S): <br /> Transfer/Processing Report(tlatetl 2014). <br /> LOCAL USEIPLANNING PERMITS:Included in appendix in the RCSI and TPR(dated 2014) ®EIR SCH#2001052081 dated December 2002 <br /> El LOCATION MAP:Figure 1 in RCSI and TPR(dated 2014) ❑MND/ND <br /> MITIGATION MONITORING IMPLEMENTATION SCHEDULE:December 2002 ❑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/FINAL <br /> C. IF APPLICABLE: <br /> REPORT OF WASTE DISCHARGE ®DEPT.OF HEALTH SERVICES PERMIT <br /> CONTRACT AGREEMENTS ®SWAT(Air and water) <br /> MSTORMWATER PERMIT APPLICATION ®WETLANDS PERMITS <br /> ❑NPDES PERMIT APPLICATION ®OTHER: <br /> VERIFICATION OF FIRE DISTRICT COMPLIANCE <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 /> E]SOLE PROPRIETORSHIP ❑PARTNERSHIP ❑✓ CORPORATION EIGOVERNMENTAGENCY <br /> OWNER(S)OF LAND SSN OR TAX ID# <br /> Forward Inc. 941544481 <br /> ADDRESS,CITY,STATE,ZIP: 9999 S.Austin Road,Manteca,CA 95336 TELEPHONE#:(209)982-4298 <br /> FAX#: (209)982-1009 <br /> E-MAIL ADDRESS:Efanning@republicservices.com <br /> CONTACT PERSON(Print Name): <br /> Erin Fanning <br /> Page 3 <br />