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6 i <br />Page 6 <br />CALIFORNIA ENVIRONMENTAL Mate of California�aanaas <br />PROTECTION AGENCY Regional Water Quality Control Board Fir I...... c 7 <br />APPLICATIONIREPORT OF WASTE DISCHARGE yY� <br />GENERAL INFORMATION FORM FOR <br />WASTE DISCHARGE REQUIREMENTS OR NPDES PERMIT <br />IL TYPE OF DISCHARGE <br />Check Type of Discharge(s) Described in this Application (A or B): <br />Fv A. WASTE DISCHARGE TO LAND ❑ B. WASTE DISCHARGE TO SURFACE WATER <br />Check all that apply: <br />❑Domestic/Municipal Wastewater❑Anima! <br />Treatment and Disposal <br />❑ Animal Waste Solids <br />or Aquacultural Wastewater <br />❑ Cooling Water <br />❑ Land Treatment Unit <br />❑ <br />Biosolids/Residual <br />❑ Mining <br />❑ Dredge Material Disposal <br />❑ <br />Hazardous Waste (see instructions) <br />❑ Waste Pile <br />❑ Surface Impoundment <br />❑ <br />Landfill (see instructions) <br />❑ Wastewater Reclamation <br />❑ Industrial Process Wastewater <br />❑ <br />Storm Water <br />Other, please describe: <br />III. LOCATION OF THE FACILITY <br />Describe the physical location of the facility. <br />1. Assessor's Parcel Number(s) 2. Latitude 3. Longitude <br />Facility: Facility: 37.87N Facility: 121.22W <br />Discharge Point: Discharge Point: 37.87N Discharge Point: 121.22W <br />IV. REASON FOR FILING <br />❑ New Discharge or Facility ❑Changes in Ownership/Operator (see instructions) <br />❑ Change in Design or Operation ❑ Waste Discharge Requirements Update or NPDES Permit Reissuance <br />0 Change in Quantity/Type of Discharge ❑ Other: <br />V. CALIFORNIA ENVIRONMENTAL QUALITY ACT (CEQA) <br />Name of Lead Agency: San Joaquin County Community Development Department _ <br />Has a public agency determined that the proposed project is exempt from CEQA? ❑ Yes ❑✓ 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: <br />Has a "Notice of Determination" been filed under CEQA? ❑ Yes EN. <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 />Expected CEQA Completion Date: August 2088 <br />r.- 20016/97) <br />