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A. i I MAXIMUM <br />PR�iaNr oR PRO <br />ros D <br />DAILY <br />'low (IN M(1 1, <br />C. SOLID WASTE DISPOSAL I owlLtl RlawnT/rtl <br />OITa (IN TONS OR I <br />CUq/C YARDS): 1 9 Q Mnra <br />Vt. QUANTITY OF WASTES <br />1 ARRA" 16. O <br />I l <br />I <br />TOTAL IN ►L <br />A <br />C <br />K OUANTITe 1 D. AREA IN WHICH SOIL WILL 1 <br />1 —A - (IN ACRES) <br />IN MOD <br />ED I TOTAL $ITS AREA -- <br />V I1. LOCATION OF POINT OF DISPOSAL, OR OPERATION <br />(DESIGN AND ATTACH MAP, SKETCH, OR LOCATION ON U.S.G.S. QUADRANGLE MAP, 7.5 OR 15 MINUTE Sle ii j <br />LIST DISTANCES OR BEARING AND DISTANCE FROM SECTION CORNER OR QUARTER CORNER. SECTION, TOWNSHIP, RANGE, BASE AND MERIDIAN: <br />r®ximsitob 2200( nc>arth of hP tstnnth s�ract COl►IIeP of SeCti4n 23 TIN RGB <br />M - D - 1R - M - (see Plate 1. 1 of Attached Relport of Waste Discharge) A <br />Vill. SOURCE OF WATER SUPPLY ICNRCK ALL AP►RO►*IAT&i - <br />A.`1 MUNICIPAL OR UTILITY SERVICE: <br />NAMR OF WATRR PVRWCVOR <br />(Atv6o�VtRDt101Rktm _ <br />B. ® INDIVIDUAL (Wells) <br />C. ® SURFACE SUPPLY: <br />NAY& OF STRRAM, LAKC, ZVOINO, RTC. IF NAMR01 <br />Ttl►i OF fATRR R16NTS INAT&R RIRNTE ►&KNIT OR yCRNfR • <br />® Riparian Appropriation j <br />IX. ENVIRONMENYAL IMPACT REPORT IEIRI <br />Has an EIR been prepared for this project? Yes ® No <br />If "Yes", please enclose a copy. <br />If "No", will an EIR be prepared? � Yes ® NO <br />Will a negatioe declaration be prepared? ❑ Yes ®No <br />If "Yes". please answer the following: RNO A{LL PR&PARR TNR NROAT.WU w► ROX. OAT& OF COMPLRTION <br />I hereby certify under penalty of perjury that the information provided in this application and in any attach- <br />ments is true and accurate tqMe best of my knowledge. I-- <br />ROFF <br />PRtNTKO OR TYPR <br />M <br />TITL& =7 - <br />VI Ci P';Lc—s;��1- �j- <br />SIGNATURE OF Ot9UtA=� L_O_.._.WACl Ll <br />PRINTSO OR TY►RD NAME[ <br />TITL) OAT& <br />L 1 - 0 .P l` 55 i f) 1= A!T <br />1- I:'i-- `i I <br />LIST TITLES OF ANY ATTACHMENTS: <br />Y <br />} , µ Al <br />db 1d� <br />e f, <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 93250 of the State Water Cods, or to complete your permit application pursuant to Government Code <br />Section 66796.30 and Health and Safety Code Section 25200. <br />