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a <br /> CALIFORNIA REGIONAL WATER QUALITY CONTROL BOARD <br /> CENTRAL VALLEY REGION <br /> ORDER NO. R5-2003-0044 <br /> ATTACHMENT A <br /> TO <br /> GENERAL ORDER FOR LAND DISPOSAL <br /> OF GROUNDWATER AND SURFACE WATER FROM CLEANUP OF <br /> PETROLEUM FUEL POLLUTION <br /> APPLICATION REQUIREMENTS <br /> A Report of Waste Discharge.(Form 200 plus supplemental information) and filing fee must <br /> be submitted to the Regional Water Quality Control Board, Central Valley Region (Regional <br /> Board) for each proposed discharge. The Report of Waste Discharge shall be prepared by or <br /> under the direction of a California Registered Civil Engineer, Registered Geologist, or <br /> Certified Engineering Geologist and shall provide at least the following information or, if a <br /> Problem Assessment Report (or functional equivalent) has been approved, it may be <br /> submitted. Additional data may be requested for specific sites. <br /> A. Wastewater treatment system and characteristics <br /> I. Description of event(s), which caused the waste to be discharged to <br /> groundwater pollution, including type and source of the waste constituents and <br /> date(s)when the discharge occurred and was discovered. <br /> 2. Narrative and schematic descriptions of the proposed extraction, treatment, and <br /> disposal systems. The designated disposal area must be shown on a map with an <br /> accuracy of plus or minus two feet. If the proposed treatment system uses <br />€ activated carbon, submit an estimate of the breakthrough time for each carbon <br /> treatment unit. <br /> i <br /> 3. Any water supply well, and surface waters, within 0.5 miles of the site shall be <br /> identified on a map. <br /> N <br /> 4. A map showing the location of the facility, plume, extraction well(s), <br /> monitoring wells,treatment system, disposal facilities and site boundaries. <br /> j 5. The anticipated average and maximum flows from the treatment system. <br /> 6. An operation plan describing general operations and maintenance procedures, <br /> t <br /> process controls,monitoring and pumping rates. <br /> 7. Representative data for the following analyses of the groundwater that will be <br /> treated and discharged: (note: required quantitation (or reporting) limits are <br /> found in Part C.1 of this Order). <br />