Laserfiche WebLink
r&7rDCr1G11 AGrdfcr Rq�ml Water Qutdity Control Board <br /> <L %"'j APPLICATIONIREPORT OF WASTE DISCHARGE f <br /> GENERAL INFORMATION FORM FOR <br /> WASTE DISCHARGE REQUIREMENTS OR NPDES PERMIT <br /> VI. OTHER REQUIRED INFORMATION <br /> 1 Please provide a COMPLETE characterization of your discharge. A complete ehatacterization includes, <br /> but is not limited to,design and actual flows,a list of constituents and the dischargc concentration of each <br /> constituent,a list of other appropriate waste discharge characteristics,a description and schematic drawing <br /> of all treatment proccsscs,a description of any Best Management Practices(BMPs)used,and a description <br /> of disposal methods. <br /> 1 Also includes site map showing the location of the facility and,if you are subminiag this application for an <br /> NPDSS permit,identify the surface water to which you propose to discharge. Please try to limit your maps <br /> to a scale of 1:24,000(7.5'USGS Quadrangle)or a stfcct map,if more appropriate. <br /> iVI1. OTIIER <br /> Attach additional tbteu to arptoin any rapoatet which seed rl"rattan. lei attachments with lldes and dated tmto. . <br /> Reclaimed Facility Wastewater will be used for agricultural irrigation at two <br /> properties including Jepsen Webb Ranch and Valley Thoroughbred Farm, <br /> ' which are located East of the Facility. <br /> Yon waf be so"ley a repeafaaudre of tht RVVQCH wilUa 30 days of recdpi of y.w apprL"1;0 . 11re soca Will atam If your <br /> applieatta.b complete or if there h addldond lafomadon y"wast mh"I to samplers year ApprlvdadR<pnrt ar w,Ae n6r1rr, <br /> Pursuant to DiviJw 7,Setdon 13260 of the CaUotda water Coda <br /> VI I.CERTIFICA ILON <br /> "I certify ander„salty of taw that uta dacameat,Indudenp aA arackwenh sad rappttwenul Iuforuattoa,were prepared oder ry <br /> 41Mdon and s.Ptttidaa In aaordas c witk a sysaeta dedprod to ague that quaAAed per.auud properly gathered ad""luted rho <br /> tnforLatlos sabt d9& anal an My tagWry of the pends er perwus win wannt Ike lyrtaa,or thane pupas direeay rt"PA tc for <br /> aash.riaa she befotmadou.the lafersaatt" rnbml"It,to the bat of any krwwldae and Wkf,trac,asearale,and ooapleaa Ian aware <br /> that Aerc arc anpnirksat pendnes for sabritting floe inrormatloa, indndim�g the <br /> ponlblllty of fine and fmpriseautal" <br /> PrintNatue: .-0-17i <br /> ' (Z 421 <br /> 7 <br /> ' FOR OFFICE USE ONLY <br /> k Perm 3o0 Peedvod; 6alterw wl'.rgn Poe AmeaM R.tetved: CT.ck r: <br /> ' Far.]eoN/PI <br />