Laserfiche WebLink
Page 2 <br /> CALIFORNIA ENVIRONMENTAL Slate of California ��e=�^`°� r <br /> PROTECTION AGENCY '+s <br /> Regional Water Quality Control Board = <br /> APPLICATION/REPORT OF WASTE DISCHARGE ;`.,� r <br /> GENERAL INFORMATION FORM FOR _ + <br /> WASTE DISCHARGE REQUIREMENTS OR NPDES PERMIT • e,r„a",,,. <br /> II. TYPE OF DISCHARGE <br /> Check Type of Discharge(s) Described in this Application(A or B): <br /> ® A. WASTE DISCHARGE TO LAND ❑ B. WASTE DISCHARGE TO SURFACE WATER <br /> Check all that apply: - <br /> ❑ Domestic/Municipal Wastewater animal Waste Solids El Animal or Aouacultural Wastewater <br /> Treatment and Disposal F-1 <br /> ❑ Cooling Water ❑ Land Treatment Unit XE BiosolidwResiduai <br /> _ ❑ Mining ❑ Dredge Material Disposal ❑ Hazardous Waste (see instructions) <br /> ❑ Waste Pile ❑ Surface Impoundment ❑ Landfill (see instructions) <br /> Wastewater Reclamation I—K] Industrial Process Wastewater ❑ Storm Water <br /> ❑ Other, please describe: Winery wastewater <br /> III. LOCATION OF THE FACILITY <br /> _ Describe the physical location of the facility. <br /> L Assessor's Parcel Number(s)7- Latitude 3_ Longitude <br /> Facility: 025-080-02 Facility: N 38.12 Facility: W 121.57" <br /> Discharge Point: 025-080-02 Discharge Point: N 38.12 Discharge Poinr.W 121.57” <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 _ <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 Exempdon/Ageney: <br /> Has a "Notice of Determination" been riled 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: <br />