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Check all that apply: <br />Domestic/Municipal Wastewater <br />Treatment and Disposal <br />El Cooling Water <br />El Mining <br />Waste Pile <br />Wastewater Reclamation <br />Other, please describe: <br />E Animal Waste Solids <br />E Land Treatment Unit <br />E Dredge Material Disposal <br />E Surface Impoundment <br />E Industrial Process Wastewater <br />El Animal or Aquacultural Wastewater <br />B iosolids/Residual <br />E Hazardous Waste (see instructions) <br />El Landfill (see instructions) <br />E Storm Water <br />See attached project report <br />Di New Discharge or Facility <br />LI Change in Design or Operation <br />E Change in Quantity/Type of Discharge <br />E Changes in Ownership/Operator (see instructions) <br />El Waste Discharge Requirements Update or NPDES Permit Reissuance <br />Other: <br />Page 2 <br />CALIFORNIA ENVIRONMENTAL <br />State of California <br />PROTECTION AGENCY <br />Regional Water Quality Control Board <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 Type of Discharge(s) Described in this Application (A or B): <br />IZ A. WASTE DISCHARGE TO LAND <br /> <br />E B. WASTE DISCHARGE TO SURFACE WATER <br />III. LOCATION OF THE FACILITY <br />Describe the physical location of the facility. <br />1. Assessor's Parcel Number(s) <br />Facility: <br />Discharge Point: <br />2. Latitude 30 0 -42' <br />Facility: <br />Discharge Point: <br />3. Longitude 1 <br />Facility: <br />Discharge Point: <br />21- ° -26 <br />APN 248-070-02,11,12,13,14 <br />APN 248-090-03,04 <br />IV. REASON FOR FILING <br />V. CALIFORNIA ENVIRONMENTAL QUALITY ACT (CEQA) <br />Name of Lead Agency: San Joaquin Community Developrapnt ilepartment <br />Has a public agency determined that the proposed project is exempt from CEQA? Yes El 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: See section 6 of attached project report <br />Has a "Notice of Determination" been filed under CEQA? 1=1 Yes E 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 />Egi Negative Declaration Expected CE0.1k Completion Date: <br /> <br />;c, m 2C016/97;