HomeMy WebLinkAbout1620 e brundage _envirotech report 6.22.20_46-126F. BILLING ADDRESS: Address where annual fee invoices should be sent,
person to contact, and phone number. If identical to B. above, enter "same as
owner".
11. TYPE OF DISCHARGE
Mark the appropriate box to describe whether the waste will be discharged to: Land
or Surface Water.
Check the appropriate box(es) which best describe the activities at your facility.
Hazardous Waste: If you check the Hazardous Waste box, STOP and contact a
representative of the RWQCB for further instructions.
Landfills: A separate form, APPLICATION FOR SOLID WASTE FACILITY
PERMIT/WASTE DISCHARGE REQUIREMENTS, California Integrated Waste
Management Board Form E-1-77, may be required. Contact a RWQCB
representative to help determine the appropriate form for your discharge.
Ill. LOCATION OF THE FACILITY
• Enter the Assessor's Parcel Number(s) (APN), which is located on the property
tax bill. The number can also be obtained from the County Assessor's Office.
Indicate the APN for both the facility and the discharge point.
• Enter the Latitude of the entrance to the proposed/existing facility and of the
discharge point. Latitude and longitude information can be obtained from a U.S.
Geological Survey quadrangle topographic map. Other maps may also contain
this information.
• Enter the Longitude of the entrance to the proposed/existing facility and of the
discharge point.
IV. REASON FOR FILING
NEW DISCHARGE OR FACILITY: A discharge or facility that is proposed but does
not now exist, or that does not yet have WDRs or an NPDES permit.
CHANGE IN DESIGN OR OPERATION: A material change in design or operation
from existing discharge requirements. Final determination of whether the reported
change is material will be made by the RWQCB.
CHANGE IN QUANTITY/TYPE OF DISCHARGE: A material change in
characteristics of the waste from existing discharge requirements. Final
determination of whether the reported change would have a significant effect will be
made by the RWQCB.
CHANGE IN OWNERSHIP/ OPERATOR: Change of legal owner of the facility.
Complete Parts 1, Ill, and IV only and contact the RWQCB to determine if additional
information is required.
Form 200 (10/97) 4