Laserfiche WebLink
Page 6 <br /> CALIFORNIA ENVIRONMENTAL State of California �aanaas <br /> PROTECTION AGENCY Regional Water Quality Control Board Fir I ...... c 7 <br /> APPLICATIONIREPORT OF WASTE DISCHARGE yY� � r <br /> GENERAL INFORMATION FORM FOR <br /> WASTE DISCHARGE REQUIREMENTS OR NPDES PERMIT <br /> IL TYPE OF DISCHARGE <br /> Check Type of Discharge(s)Described in this Application (A or B): <br /> Fv A.WASTE DISCHARGE TO LAND ❑B.WASTE DISCHARGE TO SURFACE WATER <br /> Check all that apply: <br /> ❑ Domestic/Municipal Wastewater ❑ <br /> Treatment and Disposal ❑ Animal Waste Solids Anima! or Aquacultural Wastewater <br /> ❑ Cooling Water ❑ Land Treatment Unit ❑ Biosolids/Residual <br /> ❑ Mining ❑ Dredge Material Disposal ❑ Hazardous Waste (see instructions) <br /> ❑ Waste Pile ❑ Surface Impoundment ❑ Landfill (see instructions) <br /> ❑ Wastewater Reclamation ❑ Industrial Process Wastewater ❑ Storm Water <br /> Other, please describe: <br /> III. LOCATION OF THE FACILITY <br /> Describe the physical location of the facility. <br /> 1. Assessor's Parcel Number(s) 2. Latitude 3. Longitude <br /> Facility: Facility: 37.87N Facility: 121.22W <br /> Discharge Point: Discharge Point:37.87N Discharge Point: 121.22W <br /> IV. REASON FOR FILING <br /> ❑ New Discharge or Facility ❑Changes in Ownership/Operator(see instructions) <br /> ❑ Change in Design or Operation ❑Waste Discharge Requirements Update or NPDES Permit Reissuance <br /> ❑✓ Change in Quantity/Type of Discharge ❑Other: <br /> V. CALIFORNIA ENVIRONMENTAL QUALITY ACT (CEQA) <br /> Name of Lead Agency: San Joaquin County Community Development Department _ <br /> Has a public agency determined that the proposed project is exempt from CEQA? ❑Yes ❑✓ No <br /> If Yes,state the basis for the exemption and the name of the agency supplying the exemption on the line below. <br /> Basis for Exemption/Agency: <br /> Has a "Notice of Determination" been filed under CEQA? ❑ Yes ❑✓ No <br /> If Yes, enclose a copy of the CEQA document, Environmental Impact Report,or Negative Declaration. If no, identify the <br /> expected type of CEQA document and expected date of completion. <br /> Expected CEQA Documents: <br /> ❑ EIR ❑ Negative Declaration Expected CEQA Completion Date: August 2088 <br /> [ozm.zoo tb/97y <br />