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Page 3 CALIFORNIA ENVIRONMENTAL State of California 9 VnCES PROTECTION AGENCY Regional Wa ter Quality Control Board �e P� ...,„ cOyp APPLICATION/REPORT OF WASTE DISCHARGE W` Abo GENERAL INFORMATION FORM FOR WASTE DISCHARGE REQUIREMENTS OR NPDES PERMIT • CAL".NN'P II. TYPE OF DISCHARGE. Check the appropriate box to describe whether the waste will be discharged to: A. Land, or B. Surface Water. -- Check the appropriate box(es) which best describe the activities at your facility. Hazardous Waste - If you check the Hazardous Waste box, STOP and contact a representative of the RWQCB for further instructions. Landfills - A separate form, APPLICATION FOR SOLID WASTE FACILITY PERMIT/WASTE DISCHARGE REQUIREMENTS, California Integrated Waste Management Board Form E-1-77, may be required. Contact a RWQCB representative to help determine the appropriate form for your discharge. Imo. LOCATION OF THE FACILITY I. Enter the Assessor's Parcel Number(s) (APN), which is located on the property tax bill. The number can also be obtained from the County Assessor's Office. Indicate the APN for both the facility and the discharge point. 2. Enter the Latitude of the entrance to the proposed/existing facility and of the discharge point. Latitude and longi- tude information can be obtained from a U.S. Geological Survey quadrangle topographic map. Other maps may also contain this information. 3. Enter the Longitude of the entrance to the proposed/existing facility and of the discharge point. IV. REASON FOR FILING NEW DISCHARGE OR FACILITY: A discharge or facility that is proposed but does not now exist, or that does not yet have WDRs or an NPDES permit. CHANGE IN DESIGN OR OPERATION: A material change in design or operation from existing discharge requirements. Final determination of whether the reported change is material will be made by the RWQCB. CHANGE IN QUANTITY/TYPE OF DISCHARGE: A material change in characteristics of the waste from existing discharge requirements. Final determination of whether the reported change would have a significant effect will be made by the RWQCB. r CHANGE IN OWNERSHIP/OPERATOR: Change of legal owner of the facility. Complete Parts I, III, and IV only and contact the RWQCB to determine if additional information is required. WASTE DISCHARGE REQUIREMENTS UPDATE OR NPDES PERMIT REISSUANCE: WDRs must be updated periodically to reflect changing technology standards and conditions. A new application is required to reissue an NPDES permit which has expired. OTHER: If there is a reason other than the ones listed, please describe the reason on the space provided. (If more space is needed, attach a separate sheet.) r Form 200(6/97)