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CALIFORNIA REGIONAL WATER QUALITY CONTROL BOARD <br />CENTRAL VALLEY REGION <br />ATTACHMENT A TO <br />GENERAL ORDER NO. 92-150 <br />FOR DISCHARGE OF GROUND WATER FROM CLEANUP <br />OF PETROLEUM FUEL POLLUTION <br />TO SURFACE WATERS <br />APPLICATION REQUIREMENTS <br />An NPDES Application for Permit to Discharge (Forms 1 and 2D), a Report of Waste <br />Discharge (Form 200 plus supplemental information) and filing fee must be <br />submitted for each proposed discharge. The Report of Waste Discharge shall be <br />prepared by a California Registered Civil Engineer, Registered Geologist, or <br />Certified Engineering Geologist and shall provide at least the following <br />information or if a Problem Assessment Report has been approved it may be <br />submitted. The Report of Waste Discharge shall be signed by a person meeting the <br />qualifications listed in Reporting Requirements D.6 of Standard Provisions. <br />Additional data may be requested for specific sites. <br />A. Wastewater treatment system and characteristics <br />An evaluation of land disposal options, including discharge to <br />municipal wastewater collection system, and justification for selecting <br />a surface water disposal alternative. <br />Description of event(s) which caused the ground water pollution, <br />including type and source of the contaminants and date(s) when the <br />discharge occurred or was discovered. <br />Narrative and schematic descriptions of the proposed extraction, <br />treatment, and disposal systems. If the proposed treatment system uses <br />activated carbon, submit an estimate of the breakthrough time for each <br />carbon treatment unit. <br />A map(s) showing the location of the facility, plume, extraction <br />well(s), monitoring wells, treatment system, disposal facilities, site <br />boundaries, and the flow path of the proposed discharge to a major <br />river or lake. <br />Any water supply wells, and surface waters within 0.5 miles of the site <br />shall be identified on the map. <br />The anticipated average and maximum flows from the treatment system, <br />and the design flow of the treatment and disposal systems. <br />An operation plan describing general operations and maintenance <br />procedures, process controls, monitoring and pumping rates shall be <br />supplied. <br />A minimum of one of each of the following analyses of the ground water <br />which will be treated and discharged: <br />a. Chlorinated volatile hydrocarbons (EPA Method 601 or 8010)