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STATE OF CALIFORNIA <br /> THE RESOURCES AGENCY OF CALIFORNIA <br /> CAL IFCRNIA REGIONAL WATER QUALITY CONTROL BOARD <br /> REPORT OF WASTE DISCHARGE' FOR USE OF REGION <br /> Pursuant to division 7 of the State Water node wRCB Form 200 Rec' L41 t <br /> y<1 r 1 <br /> (A) REF'OF'T FROM: c fluty Foe', <br /> Discharger <br /> Unite C State5--�Q+hol CQr[)t�rat'an Letter to 1 { <br /> tOwner of Facility,Municipality,County,Dl.trict, Firm or lnd'vldual) Discharger. rJ- <br /> 12470 E. Locke Roan, Lockeford, CA 95237 � t } <br /> }Aalling Address - - ----.--- Report Rec is <br /> Zip Coda Effective Date: <br /> Telephone Na. 209 727-551 . <br /> Same as Above <br /> f;sme of Fac llkty <br /> IB) DESCRIPTION: <br /> 1, WASTE DISCHARGE:Icheck) <br /> Z. Existing discbarge------------_ ----- ( ) <br /> 3. Increase in q"ranbty of discharge_ ,.______-.. .__ I XX <br /> 4. Change in character of waste_....____ <br /> 5. Change in place or method of disposal-- ------ ( ) <br /> If. LOCATION OF POINT OF DISPOSAL OR OPERATION (describe and attach map,snatch or locate or,USGS Quadrangle map,7.5 minute series,) <br /> List distances or tearing and distance f,-r, s;;ctien cornt,or nuarter sou r,Sactlor.Trrwra)r.r,R*rge a.^.d On:e arA fier!di=n.) <br /> Attached <br /> III. WASTE TREATMENT OR DISPOSA4-'r'ACILITIES.(check) <br /> 1. Construction of entlrOy new facilltles_--_ <br /> 2. Enlargemnt of exi,,ling facHities_ z � <br /> efn-g- <br /> 3. Other(explain}_ e eXl l � ___ _ 1~ 9ndS r <br /> (C) TYPE.OF WASTE DISCARGv:(check) <br /> 1. Sewageonty_ NffiC_ I t1C__-,__.---_-(X4 <br /> 2. Industrial wastes only-ponds—-- _-__ IX)t <br /> 3. Mixed sewa&e and Industrial wastes_-________ ( ) (D) QUANTITY OF'WA3TES: <br /> 4.-Solid wastes__________a_..__ ___^ ( ) ). Present or proposed flow in midi <br /> '0�_ 367 <br /> 2. Design flow(fn mpd) .400 <br /> 3. Present papulation �7 <br /> 5. Cattlewastes._-_---- ��____( ) 4. Design population �''i.—��� <br /> 6. Safi,ail;,clay,etc._-_----_- --__( ) 5. So'id write Pksposal site None <br /> (}n cunie yards)_ ---- -- ____ <br /> b. Area in wriich soil will be cisbirbed !done <br /> Y. Other wastes_ _-_ __--_^____-__.._( } (In acees)-- <br /> (E) SOURCE CF WATER SUPPLY: <br /> 1. Hunicipat or utolty service( } <br /> Z irv+ividuel wells (XX <br /> 3. Surface supply: (a) Name:of Stream <br /> (b) Type of Weter Rights: Ripsrian( Appropriat'on( ) <br /> (c) W'ete:P liffh s Permit or Llrutae Numoer <br /> (F' EN00Ef2',,7NMI tTAL lfrlFACT R'.PR T kE."R):� <br /> 1. Has an Elft been prepared for this project? <br /> Yes ( ) No ( ) <br /> 2. If yes, please emlosp a copy <br /> 3. if no, will an o_IF be prepared? Yes ; ) No ( ) <br /> 4. if yes,WhO will prepare the EIR? <br /> A;L OF iriE STATE FWTS",r T;rjHlrr`HERFI'N ARE TRUE AND CCRR,.-::T TO rHF Bt-ST Oar VY KNOWLEDGE.AND DELIEF ANU ARL <br /> Stjj-^M':TTEC UNDER PENALTY OF PEFt}URY. /+ <br /> SIG.m7UnE OFAUTtiOR12FD PERSO6 .�, : � 7 t` <br /> 704- Assn;. SecretcarL- —._ <br /> i.lrrk, Fngineei,Consultant,etc.) <br /> You will bt notifies of the correctness sof N Erni`,e and sut*iittal of any;dui43oral informitirNs.."_.:r c,u.6 aectssary to cc,nplste your Repurt tri waste <br /> Disctariie pursuAni to Division 7,Sac`ion 1320 or the State rata+',ode, <br /> WRCfS F OR:A 7.00 iRE"J.7 7/1/76) , <br /> r <br />