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CALIFORNIA ENVIRONMENTAL Page 6 <br /> PROTECTION AGENCY State Of Califormia P¢ c u,,,a c <br /> Regional Water Quality Control Board <br /> APPLICATION/REPORT OF WASTE DISCHARGE :p '° <br /> GENERAL INFORMATION FORM FOR :�� �° <br /> WASTE DISCHARGE REQUIREMENTS OR NPDES PERMIT Fm _,r <br /> �4l�vo P�'P <br /> II. TYPE OF DISCHARGE <br /> Check Type of Discharge(s)Described in this Application (A Q B): <br /> ❑ A.WASTE DISCHARGE TO LAND E] B.WASTE DISCHARGE TO SURFACE WATER <br /> FWastePile <br /> at apply: <br /> c/Municipal Wastewater <br /> nt and Disposal ❑ Animal Waste Solids ❑ Animal orAquacultural Wastewater <br /> Water ❑ Land Treatment Unit ❑ Biosolids/Residual <br /> ❑ Dredge Material Disposal ❑ Hazardous Waste (see instructions) <br /> ile ❑ Surface Im oundment ❑ LandfillP (see instructions) <br /> ter 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) ADischarge <br /> Facility: [Discharge <br /> APoint: <br /> Discharge Point: oint: <br /> _7 <br /> IV. REASON FOR FILING <br /> EDNew arge or Facility ❑Changesin Ownership/Operator(see instructions) <br /> esign or Operation ❑Waste Discharge Requirements Update or NPDES Pennt Reissuance <br /> uantity/Type of Discharge ❑Other: <br /> V. CALIFORNIA ENVIRONMENTAL QUALITY ACT (CEQA) <br /> Name of Lead Agency: <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: <br /> eo�r,¢oa is/sn <br />