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STATE OF CALIFORNIA <br /> THE RESOURCES AGENCY OF CALIFORNIA <br /> 107,ALIFORNIA REGIONAL WATER QUALITY CONTROL BOA <br /> REPORT OF WASTE DISCHARGE FOR USE OF REGIONAL BOARD <br /> Pursuant to Division 7 of the State Water Code WRCB Form 200 Recd: - <br /> (A) REPORT FROM: California Clay Products, Duty Fee:4-'1 6'C) <br /> Discharger a California t---- at on Letter to <br /> (Owner of Facility,Municipality,County,District, Firm or Individual) Discharger: <br /> Mailing Address 305 El Dorado t. w �a� to Report Rec'd: <br /> Stockton® CA 95202 Zip Code <br /> Effective Date: <br /> Telephone No. (/ <br /> Name of Facility Cal^C1a Abandon�� lc1 t �, �J3�S <br /> (B) DESCRIPTION: <br /> I. WASTE DISCHARGE:(check) <br /> 1. New discharge-_--._..__..__-------- ( ) <br /> 2. Existing discharge•------------- ®- ) <br /> 3. Increase in quantity of discharge....._ ___.._•-_ ( ) <br /> 4. Change in character of waste_....__--•• -____.__ ( ) <br /> S. Change in place or method of disposal--_____-_,- ( ) <br /> 11. LOCATION OF POINT OF DISPOSAL OR OPERATION(describe and attach map,sketch or locate on USGS Quadrangle map,7.5 minute series.) <br /> List distances or bearing and distance from section corner or quarter corner,Section,Township,Range and Base and Meridian.) <br /> rnia <br /> III. WASTE TREATMENT OR DISPOSAL FACILITIES:(check) <br /> 1. Construction of entirely new facilities_._ <br /> 2. Enlargement of existing facilities-_---- -----( ) <br /> 3. Other(explain) <br /> (C) TYPE OF WASTE DISCHARGE:(check) <br /> 1. Sewage only_ <br /> 2. Industrial wastes only-__-_-_--_--__- ( ) <br /> 3. Mixed sewage and industrial wastes----___ ( ) inert <br /> 4.-Solid wastes--------------------X )Class III materials only, <br /> non-rater soluble, non—decomposable (see attacFied for. description) <br /> 5. Cattle wastes--_--_._--.-----------( ) <br /> 6. Soil,silt,clay,etc.---------------- <br /> ( ) <br /> 7. Other wastes- ---_-( ) <br /> (D) QUANTITY OF WASTES: <br /> 1. Present or proposed flow(in mgd) 4. Design population <br /> 5. Solid waste disposal site <br /> 2. Design flow(in mgd) <br /> 3. Present population (in cubic yards) SE3e attached <br /> 6. Area in which soil will be disturbed <br /> (in acres) 10 acres <br /> (E) SOURCE OF WATER SUPPLY: <br /> 1. Municipal or utility service( ) See attached. <br /> 2. Individual wells ( ) <br /> 3. Surface supply: (a) Name of Stream <br /> (b) Type of Water Rights: Riparian( ) Appropriation( ) <br /> (c) Water Rights Permit or License Number <br /> (F) AMOUNT OF FILING FEES-(See attached Fee Schedule) <br /> Amount of fee accompanying this report $ <br /> ALL OF THE STATEMENTS CONTAINED HEREIN ARE TRUE AND CORRECT TO THEB T OF Y NO GE ANp"LIEFD AR <br /> SUBMITTED UNDER PENALTY OF PERJURY. <br /> V41— <br /> SIGNATURE OF AUTHORIZED PERSON <br /> Title ✓ <br /> (Manager I inee onsultan,e .) <br /> Date N(%r+b <br /> You will be notified of the correctness of filing fee and submittal of any additional information deemed necessary to complete your Report of Waste <br /> Discharge pursuant to Division 7,Section 13260 of the State Water Code. <br /> WRCB Form 200(2-72) <br />