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v Page 3 <br /> CALIFORNIA ENVIRONMENTAL State Of Ca)IfOLIt18 � tutee <br /> PROTECTION AGENCY �� •"•"+ <br /> Regional <br /> /REPWater Quality Control <br /> ASTEazd W� ; <br /> APPLICATION/REPORT OF WASTE DISCHARGE ;`.�� <br /> GENERAL INFORMATION FORM FOR `� <br /> WASTE DISCHARGE REQUIREMENTS OR NPDES PERMIT <br /> II. TYPE OF DISCHARGE <br /> Check the appropriate box to describe whether the waste will be discharged to: A. Land, or B. Surface Water. <br /> Check the appropriate box(es) which best describe the activities at your facility. <br /> Hazardous Waste - If you check the Hazardous Waste box, STOP and contact a representative of the RWQCB for <br /> further instructions. <br /> Landfills - A separate form, APPLICATION FOR SOLID WASTE FACILITY PERMIT/WASTE DISCHARGE <br /> REQUIREMENTS, California Integrated Waste Management Board Form E-1-77, may be required. Contact a <br /> RWQCB representative to help determine the appropriate form for your discharge. <br /> III. LOCATION OF THF FACILITY <br /> I. Enter the Assessor's Parcel Number(s) (APN), which is located on the property tax bill. The number can also be <br /> obtained from the County Assessor's Office. Indicate the APN for both the facility and the discharge point. <br /> 2. Enter the Latitude of the entrance to the proposed/existing facility and of the discharge point. Latitude and longi- <br /> tude information can be obtained from a U.S. Geological Survey quadrangle topographic map. Other maps may <br /> also contain this information. <br /> 3. Enter the Longitude of the entrance to the proposed/existing facility and of the discharge point. <br /> LV. REASON FOR FILING <br /> NEW DISCHARGE OR FACILITY: <br /> A discharge or facility that is proposed but does not now exist, or that does not yet have WDRs or an NPDES permit. <br /> CHANGE IN DESIGN OR OPERATION: <br /> A material change in design or operation from existing discharge requirements. Final determination of whether the reported <br /> change is material will be made by the RWQCB. <br /> CHANGE IN QUANTITY/TYPE OF DISCHARGE: <br /> A material change in characteristics of the waste from existing discharge requirements. Final determination of whether the <br /> reported change would have a significant effect will be made by the RWQCB. <br /> CHANGE IN OWNERSHIP/OPERATOR: <br /> Change of legal owner of the facility. Complete Parts 1, III, and IV only and contact the RWQCB to determine if additional <br /> information is required. <br /> WASTE DISCHARGE REQUIREMENTS UPDATE OR NPDES PERMIT REISSUANCE: <br /> WDRs must be updated periodically to reflect changing technology standards and conditions. A new application is required <br /> to reissue an NPDES permit which has expired. <br /> OTHER: <br /> If there is a reason other than the ones listed, please describe the reason on the space provided. (If more space is needed, <br /> attach a separate sheet.) <br /> Form]4016/991 <br />