HomeMy WebLinkAbout1620 e brundage _envirotech report 6.22.20_52-126VI. OTHER REQUIRED INFORMATION
I
Please provide a COMPLETE characterization of your discharge. A complete
characterization includes, but is not limited to, design and actual flows, a list of
constituents and the discharge concentration of each constituent, a list of other
appropriate waste discharge characteristics, a description and schematic drawing of all
treatment processes, a description of any Best Management Practices (BMPs) used,
and a description of disposal methods.
Also include a site map showing the location of the facility and, if you are submitting this
application for an NPDES permit, identify the surface water to which you propose to
discharge. Please try to limit your maps to a scale of 1:24,000 (7.5' USGS Quadrangle)
or a street map, if more appropriate.
Vil. OTHER
Attach additional sheets to explain any responses which need clarification. List
attachments with titles and dates below.-
You will be notified by a representative of the RWQCB within 30 days of receipt of your
application. The notice will state if your application is complete or if there is additional
information you must submit to complete your Application/Report of Waste Discharge,
pursuant to Division 7, Section 13260 of the California Water Code.
VIII. CERTIFICATION
"I certify under penalty of law that this document, including all attachments and
supplemental information, were prepared under my direction and supervision in
accordance with a system designed to assure that qualified personnel properly gathered
and evaluated the information submitted. Based on my inquiry of the person or persons
who manage the system, or those persons directly responsible for gathering the
information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting
false information, including the possibility of fine and imprisonment."
Print Name
Signature
FOR OFFICE USE ONLY
Title
Date
Date Form 200
Letter to
Fee Amount
Check #:
Received:
Discharger:
Received:
1 -1
Form 200 (10/97) 4