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('.•.•. ' STATE OF CALIFORNIA <br /> THE RESOURCES AGENCY OF CALIFORNIA <br /> CALIFORNIA REGIONAL WATER QUALITY CONTROL BOARD <br /> REPORT OF WASTE DISCHARGE* <br /> FOP.USE OF REGIO <br /> Pursuant to Division 7 of the Slott-Water Cade . � <br /> WRCS Form 200 Rec' {�G <br /> (A) REPOP7 FROtA: N</b h <br /> Duty Fee. `' <br /> Discharger - �ln�ted $�dteS OiBS a-; I 7'. lk <br /> (Owner of Fscltity,Municipality.County,Dlatrlc% Firm or Individual) Letter to <br /> s <br /> 12470 E. Locke Road, Lockeford CA 957.37 DIscharEer: <br /> Mailing Address "• IF1 <br /> ZIP Coda Report Rec'd:. - }3 i2r'L':i <br /> Telephone Na. 209 727-5511 's <br /> • Effective Date: �fI <br /> tvamealFac lllty Same as Agave <br /> (91 DESCRIPTION: r <br /> ! I. WASTE DISCHARGE:(checkl <br /> 1. NewdEschar�a-- <br /> 2. Existingdtscharge----___�________�._ ( ) <br /> 3. Increase ingtianlityefdischarge_.._______..__ (XX <br /> f 4. Change In charaeter of waste_...._-__..__--___ ( ) <br /> J S. Change In place or method of disposal--__.._____ { } <br /> it. LOCATION OF POINT OF DISPOSAL OR OPERATION (destrllxa ant attach map,sketch or locate on USGS Quadrenple map,7.5 minute series,) <br /> L.Ist distances or bealing and distance te"rr;!cdlnn cntner of ruarter Lwrmr;faction,7:3.»»shi,^,Rerge and Fa:e and l++:idi3n,} <br /> Attached <br /> 111. WASTE TREATMENT OR DISPOSAL FACILITIES:(check) <br /> i!! 1. Construction of entirely hew facilities_-________( y <br /> 2. Enlargement of exii{ling facltittee__ <br /> 3. Ocher{explain)U-s9-eXT S±j QJ.d1_ng ponds <br /> {C} TYPE OF WASTE OISCgARGt'(checxl <br /> 1. Sewag,only—_ E� <br /> 2, industrial wastes only_-P4DA 1S-- -._-____(X)t <br /> 3. 611xed sewage and Industrial waste%_ (p) QUANTITY Y!2F WASTES: <br /> 4.•Soiidwaslrs___ ( ) 05 .jlj� <br /> 1. <br /> Present or proposed flow in mid) <br /> 2. Design flow(In myd) .400 <br /> PeSnt populationS. Cattle wastes- �-=.- <br /> 4. <br /> Desigpopulation i <br /> T <br /> .1 S. Soil,sit;4 clay,etc.---__-___.___-__._( ) 5. Solid waste disposal site : - <br /> (in cuhicyarrls) `y None <br /> S. Aeea in which sail will be e5iturbsd <br /> 011mrwastts___ e•a rinser ) None ' <br /> (E) SOURCE.OF MATER SUPPLY: <br /> 1. Mdnicipa:or utility service <br /> Z individual wells (XX <br /> .'I <br /> 3. Surface supply: (r.) Nxme or Stream <br /> (b) Type of Water Rights: Riparian( ) Appropriation{ ) <br /> (c) Wale:rlifiM3 Permit or LlrQnxe Number <br /> {rill E14VIRONI,TUITAL lfilr^'AC t nF.FORT <br /> I. Has an E1R been ptewirerl for Itis ()rpje.ct? <br /> Yes ( ) No ( } <br /> 2. It yes, please enelrse a copy <br /> 3. it no, Will an t=IR be prepared? Yes ( ) No ( j <br /> 4. If yes,rrha will prepare the E IR7 <br /> ALL OF THE ST,0,TEMFN'L•e rAVITI.IktEr:HEREIN ARE TRUE AND CORRECT TO THE BEST Of MY KNUVrLEDGE AND BELIEF AND ARE <br /> SILIWITTED UNDER PENALTY OF PERJURY, f <br /> SIGNATURE OF A!JTIIORIZFG FERSOiI -- <br /> Tgie Asst. 8ec'"f?tRr'yr <br /> �Aana,;n',Meek. F_;gineer,I NrSriiF;Snt,ett.l�J-- <br /> �I <br /> YOU will b+,notified of the!on'act"t!35 41 piing f:•e and sutm-.11tal of arty,Md!00-a1 Infnrrr,etirm artt;;, ce ssory to comPlrtc y�!ur Rerurt 451'aste <br /> DisetAfee pu*wnn[to Division 7, Sachon '3261)n!the Stale wate•!',oda. <br /> WkCt3 c'CFt!4 22,0 (REV. 7 7/1/76) <br />