SITE INFORMATION AND CORRESPONDENCE

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WAIVER FORM FOR ADMINISTRATIVE CIVIL LIABILITY COMPLAINT By signing this waiver, I affirm and acknowledge the following: I am duly authorized to represent the Mountain House Community Services District(hereafter Discharger) in connection with Administrative Civil Liability Complaint R5-2015-0539 (hereafter Complaint). I am informed that California Water Code section 13323, subdivision (b), states that, "a hearing before the regional board shall be conducted within 90 days after the party has been served. The person who has been issued a complaint may waive the right to a hearing." ❑ (OPTION 1: Check here if the Discharger waives the hearing requirement and will pay in full.) a. I hereby waive any right the Discharger may have to a hearing before the Central Valley Water Board. b. I certify that the Discharger will remit payment for the proposed civil liability in the full amount of thirty nine thousand dollars ($39,000) by check that references "ACL Complaint R5-2015-0539" made payable to the State Water Pollution Cleanup and Abatement Account. Payment must be received by the State Water Resources Control Board, Accounting Office, Attn: ACL Payment at PO Box 1888, Sacramento, California, 95812-1888 by 14 October 2015. The waiver and a copy of the check must be submitted to the Central Valley Water Board at 11020 Sun Center Drive#200, Rancho Cordova California, 95670 by 14 October 2015. c. I understand the payment of the above amount constitutes a proposed settlement of the Complaint, and that any settlement will not become final until after a 30-day public notice and comment period. Should the Central Valley Water Board receive significant new information or comments during this comment period, the Central Valley Water Board's Assistant Executive Officer may withdraw the complaint, return payment, and issue a new complaint. I also understand that approval of the settlement will result in the Discharger having waived the right to contest the allegations in the Complaint and the imposition of civil liability. d. I understand that payment of the above amount is not a substitute for compliance with applicable laws and that continuing violations of the type alleged in the Complaint may subject the Discharger to further enforcement, including additional civil liability. ❑ (OPTION 2: Check here if the Discharger waives the 90-day hearing requirement in order to engage in settlement discussions.) I hereby waive any right the Discharger may have to a hearing before the Central Valley Water Board within 90 days after service of the complaint, but I reserve the ability to request a hearing in the future. I certify that the Discharger will promptly engage the Central Valley Water Board Prosecution Team in settlement discussions to attempt to resolve the outstanding violation(s). By checking this box, the Discharger requests that the Central Valley Water Board delay the hearing so that the Discharger and the Prosecution Team can discuss settlement. It remains within the discretion of the Central Valley Water Board to agree to delay the hearing. Any proposed settlement is subject to the conditions described above under"Option 1." ❑ (OPTION 3: Check here if the Discharger waives the 90-day hearing requirement in order to extend the hearing date and/or hearing deadlines.Attach a separate sheet with the amount of additional time requested and the rationale.) I hereby waive any right the Discharger may have to a hearing before the Central Valley Water Board within 90 days after service of the complaint. By checking this box, the Discharger requests that the Central Valley Water Board delay the hearing and/or hearing deadlines so that the Discharger may have additional time to prepare for the hearing. It remains within the discretion of the Central Valley Water Board to approve the extension. (Print Name and Title) (Signature) (Date)