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-�--� VL QUANTITY OF WASTES <br /> O <br /> s7lKtEMT OR ROtO/ p I MaKt+�uY I Avew Aas a. .ialam PLOT IN MG13 <br /> DAILY PLOW (on "4201: I I '� <br /> .043MGD MGQT__�.—� �14�LiQ-.------ - <br /> C' LOUD WASTE DISPOSAL I OAtLT otIANTITV I TOTAL IN PLACE OUANTt D, REA IN WHICH SOILWrLL Ma DISTUREED I Tol.L llrE..EA <br /> /$TIC (IN TONE OR I I IN ACAEfI I <br /> GUEIC TARO tI: 1 -Q- -�_ <br /> VH. LOCATION OF PQIkT OF OISPO JAI.OR OPERATION - <br /> (OE/ION AND ATTACH MAP, SKETCH,Ow LOCATION ON Y./.E.f.QUADRANGLE MAP. ILS OR !S MINUTE SIC1411m) <br /> LIST D[SYANCKS OR EEARING AND OISTANCE FROM SECTION COIINXw On QUARTER CORNER, IKCTIO", TGERSHIP. RANGE, EA/E ANO MERIDIAN: <br /> See Attachment A for U.S.G.S. quadranrIe m4p <br /> Refer to Attachment B for principal of the treatment system by Fox Environmental Services. <br /> Site plan and diagram of dischar a oints into the trench drain-type percolation_it <br /> are included as Attachment C. <br /> V111. SOURCE OF WATER SUPPLY, CMaCK.ALL APrw OrwulxEl— <br /> A. F-1 MUNICIPAL OR UTILITY SERVICE: B. FX1 INDIVIDUAL(Wdft) <br /> tiara or w.Taw •uwvarow _. ___—___ ___._ -.-....- .--__. . <br /> C. El SURFACE SUPPLT: <br /> A OPwafA o►ruwrlra� ��-� T----- nwr or lTRa AM,LAi a.9rwING.6TC. �. haMao) -� - ----- <br /> TTr OF N.rEw■tGn T! -� VIArtR Ri0Mr!raAN�r ow 4+G enf{ <br /> I <br /> El Riparian ❑ Agproprlation I <br /> '- �IX, ENVIRONMENTAL IMPACT REPORT filRI <br /> Has an EIR been prepared for this project? Yet � No <br /> If"Yes",please enclose a Copy. <br /> If"No",will an EiR be prepared? Yes a No <br /> Will a negative declaration be prepared? Yes ® No <br /> I I"Yes".please answer the following: RKo WILL►R Er Aw/TN■MEOAT VE OE CLAwAT14Hr r+Oa.uATa OY COM rLarlPti <br /> CERTIFICATION <br /> 1 hereby certify under penalty of perjury that the information provided in this application and in any attach- <br /> ments is true and accurate to the best of my knowledge. <br /> Sten VR P OW R pP AClLITT URE OPO Toa FAC LITY <br /> a O ,rT raa n.Ma -- rwln aw rT rao nwaa - <br /> TLa - OAT• TITLE 01TE <br /> LIST TITLES OF ANY ATTACHMENTS' - <br /> Attachment A: Lodi South Quadrang e, California , San Joaquin County <br /> 7.5 minute series <br /> Attachment S: Hydrocarbon Recovery System - Principle of Operations by <br /> Fox Environmental Services, Inc. <br /> Attachment C: Fast Gas, E. Highway 12, Lodi , C - Fox Envi:ranmental Services Inc. <br /> You will be notified of the correctness of filing fee and submittal of any addificirad information deemednecessery to complete your Report of Waste <br /> Discharge pursuant to Division 7, Section 13250 of the State Water Code,or to complete your perms application pursuant to Government Cods <br /> Section 66798.30 and Health and Safety Code Section 25200. <br />