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Mr. Jack Badey -5 - 14 January 2011 <br /> Type of Determination: Date of Determination: <br /> If the CEQA determination was made after the date of adoption of this General WDR, then include a copy of the <br /> CEQA determination with this NOI. <br /> 7. PROCESS <br /> ❑ Single-Injection Points ❑ Continuous Injection ❑ Recirculation System <br /> Amendments to be added: Volumes of Amendments per Storage on Site? <br /> Month: ❑ Yes ❑ No <br /> Pollutants to be treated: Rates of amendment additions: Max rate of amendment addition: <br /> Extraction and Injection Rates(give units) Treatment Methods and flows(give units): <br /> Average: Maximum: Average: Maximum: <br /> 8. WASTES GENERATED <br /> Check All That Apply: <br /> ❑ Treatment Wastewater ❑ Domestic Wastewater(separate system) <br /> ❑ Stormwater ❑ Solid waste -Type <br /> 9.AMENDMENT STORAGE <br /> Describe the type(s)of storage vessels, including capacity of each, that will be used to store amendments: <br /> How will liquid be stored and monitored to prevent spillage? <br /> 10. CERTIFICATION <br /> "I certify under penalty of law that this document and all attachments were prepared under my direction or <br /> supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate <br /> the information submitted. Based on my inquiry of the person or persons who manage the system, or those <br /> persons directly responsible for gathering the information,the information submitted is,to the best of my <br /> knowledge and belief,true, accurate, and complete. I am aware that there are significant penalties for submitting <br /> false information, including the possibility of fine and imprisonment for knowing violations." <br /> Print Name: Title: <br /> Signature: Date: <br /> AMM: 06 December 2007 <br />