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V1. QUANTITY Of WASTES <br /> • .y l rA -uM I AVRRADs I B. DESIGN PLOW IH AICD <br /> A. <br /> ' PRE■[NT OR RO rPs D r� r�r� I �,,�(� I <br /> DkILY PLOW JIM MOO - I ,Q MUL 2 1 s_Q _,---.�]L1 GM—.---A---- — ' <br /> C — DAaLV avwn Tarr I TOTALIR rLAaa OUANTITr 0, AREA IN WHICH SOIL W4:1.BE DISTUReEO I rorwL TITK ReA - <br /> 90LfD WASTE DISPOSAL ! IIN ACRE/1 I <br /> a1T[ JIM TONS OR I TO— l —r1— -- <br /> cu[Ic YARDS), I VJ ----- — — —= — — - <br /> V11, LOC ATkpN or POINT OF 015OlAL OR OPERATION <br /> (DSIQN ANO ATTACH MAP, SKIT GH,OR LOCATION ON U.S.O.S.QVADRANOLE MAA, ,/OR 11 MINUTE SERIES.) <br /> E <br /> LIST DISTANCES OR sa:ARINa AMC DISTANCE FROM SECTIOM CORNER 00 QUARTER ORNER, SECTION, TOWNSHIP, RANGE. SASE ANO M[RIDIAN: <br /> See Attachment A for U.S.G.S, quadrangle mom . <br /> Refer to Attachment B for rinci al of the treatment system_ by Fox Fnvironmental Services. <br /> Site plan and diagram of discharge points into the trench drain-type percolation pit _ <br /> are included as Attachment C. - - - - -- - <br /> VIII. SOUNC=Or WATER SUPPL Ir fCNKC'K ALL wrP OPRIATE}�-� — --- �'---~--- <br /> A. MUNICIPAL OR UTILITY SERVICE: B. INDIVIDUAL(W1110 — — --- <br /> NAA4E Or WATER PURVEVOR <br /> C. SURFACE SUPPLY: <br /> —`_`� — n Ira Or •TRswAI,LwNr.sr RING.trc. .r NwwaDl 'J` —..____—.. <br /> AODR.f[Dr ruRVarow -�--� <br /> ..- - T ha Or W-AT.Ca RIPNT[� _ I IR wTCR RIONTi PiRYIT 0/1 IIc.NfK <br /> 1 <br /> Riparian Fl Appropriation I <br /> IX. ENVIRONMENTAL IMPACT REPORT IEIR} <br /> Has an EiR been prepared for this project? � Yes � NO <br /> If"Yes",please enclose a Copy. <br /> If"No",Wil!an EIR be prepared? Yea Q No <br /> Noll a negati%a declaration be prepared? Yes ® No <br /> If"Yes please answer the following: rIIO-ILL rR ar ARE TMa w[O TIVE Di ClA w1T10Nt APPwOw.tiATa Dr cD.IPLa T. <br /> CERTIFICA ION <br /> I hereby certify under penalty of perjury that the inform tion provided in this application and in any attach- <br /> ments is true and accurate to the best of my knowledge. <br /> 7,11N �107WWPR AG ILIYY � U7_ <br /> OPO Ton O FwC LItY <br /> �S"DATA TI L11 ` PATa <br /> LIST TITLES OF ANY ATTACHMENTS: — <br /> Attachment A: Lodi South Quadrang e, California, San Joaquin County <br /> 7.5 minute series <br /> Attachment B: Hydrocarbon Recovery System - Principle of Operations by <br /> Fox Environmental Services, Inc. <br /> Attachment C: Fast Gas, E. Highway 12, Lodi , A - Fox Environmental Services Inc. - <br /> You will be notified of the correctness of filingfee and submittal of any additional information deemed necessary to complete your Report of Waste <br /> Discharge pursuant to Division 7, Section 13250 of the State Water Coda, r to complete your permit application pursuant to Goveinment Code <br /> Section 66796.30 and Health and Safety Code Section 25200. <br />