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CALIFORNIA. ravntoinaarrAL PROTECTION ACIINCY <br />State of California <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 />VI. OTHER REQUIRED INFORMATION <br />Please provide a COMPLETE characterization of your discharge. A complete characterization includes, <br />but is not limited to, design and actual flows, a list of constituents and the discharge concentration of each <br />constituent, a list of other appropriate waste discharge characteristics, a description and schematic drawing <br />of all treatment processes, a description of any Best Management Practices (BMPs) used, and a description <br />of disposal methods. <br />Also include a site map showing the location of the facility and, if you are submitting this application for an <br />NPDES permit, identify the surface water to which you propose to discharge. Please try to limit your maps <br />to a scale of 1:24,000 (7.5' USGS Quadrangle) or a street map, if more appropriate. <br />VII. OTHER <br />Attach additional sheets to explain any responses which need clarification. List attachments with titles and dates below: <br />Please see attached Project Report which identifies all <br />aspects of the proposed project. <br />You will be notified by a representative of the RWQCB within 30 days of receipt of your application. The notice will state if your <br />application is complete or if there is additional information you must submit to complete your Application/Report of Waste Discharge, <br />pursuant to Division 7, Section 13260 of the California Water Code. <br />VIII. CERTIFICATION <br />,ropwAir <br />FOR OFFICE USE ONLY <br />Date Form 200 Received: Letter to Discharger: Fee Amount Received: Check #: <br />"I certify under penalty of law that this document, including all attachments and supplemental information, were prepared under my <br />direction and supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the <br />information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for <br />gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware <br />that there are significant penalties for submitting false information, including the possibility of fine and imprisonment." <br />Print Name: Lloyd D. Hedenland, Sry-- Title: Senior Consultant, VP <br />ical Serviced Gip.,Inc. 4-3-2000 _ Date- Signature: <br />Form 200(6/97)