Laserfiche WebLink
03/24:20(5 11:10 r-As <br /> Page <br /> (;AT.IFOR1aU ifdNntOR1�aTAL State of California <br /> PRp�g09 AGENCY Regional Water Quality Control Board la APPLICATIONIREPORT OF WASTE DISCHARGEGEWERAL INFORMATION FORM FOR WASTE DISCIHARGE REQUIREMENTS OR NPDES PERMIT <br /> VI. OTHER REQUIRED INFORMATION <br /> Please protide a COMPLETE characterization of your discharge. A complete characterization includes, <br /> but is not limited to, design and actual flows,a list of cons"leDtil and the discharge concentration of each <br /> constilueot,a list of other appropriate waste discharge characteristics,a description and schematic drawing <br /> of all treatment processes,a description of any Best Management Practices(BMPs)used,and a description <br /> of disposal methods. <br /> Also include a site map showing the location of the facility and,if you are submitting this application for an <br /> NpDES 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'LJSOS Quadrangle)or a stmt map, if more appropriate. <br /> VII. OTHER <br /> Attach additional sheets to explain silly responses which aced e3aril cadde. List attachments with tides and states below: <br /> You will be notified by a representative of the RW QCB within 30 days of receipt of your application. The notice <br /> W sate in ate if your <br /> application it complete of if there is additional informatina you must Submit to complete your Application/Repo Discharge, <br /> pursuant to Division 1,Section 13260 of the California Water Code. <br /> VIII. CERTIFICATION <br /> includia <br /> "I certify rider penaltyof law that this Ootumrnt, R all attachments and supplemental information, were prepared under my <br /> direction and supervision in accordance with a n;ystem designed to assure that qualified personnel properly gathered and evaluated the <br /> information submitted. Bond on my inquiry of the person or persmts who manage the system,or those <br /> persons <br /> e onsddirectly- <br /> rIoamble for <br /> gathering the information, the information submitted is,to the brat of my knowledge and 6dief,true, e, complete. <br /> are that there are 9ibn'6cent penalties for submitting false information, including the possibilit`Of fine and imprisonment." <br /> PrintName s !'U <br /> _2e!_OS <br /> Date: <br /> Signature <br /> FOR OFFICE USE ONL1' <br /> Sete Form Z00 Received: Lenerm ischargec Fee Amount Received: Chers#o <br />