Laserfiche WebLink
' •I O•ICIAL USE ONLY <br />r <br />Date Sent: /a~~6~9~ <br />Date In: <br />Date to D.E.: <br />Date Recd. from D.E. <br />PERMIT INACTIVATION FORM <br />Facility: CO/1/N2// ~25oc~,eC'P-S <br />Legal ~ •~q,eo/ ~-O~Yivei/ <br />Contact Person: <br />Address: ~~~s S Li / <br />~./(~O~u A/e Legal Phone Number:~0.3) 667-/as ~ <br />Facility Contact: ~~ ~ e <br />Facility Contact Phone Number: <br />Location: L/1/4 S~/~ <br />Direction: <br />Conaty: ~iE~ij17Pi2 <br />Permit Number: CQ~- ~~~~~ 7 <br />Tom, i R 6 9G,/ 6~ f. /YJ <br />Please answer the following questions and sign the certification. If you have <br />nay questions regarding your facility and the information required, please <br />contact your District En;;sneer, ~/,•C ~O12 S'i4i•N z- <br />Purpose of Request ~~yIQ (~. Discharge was to [~~4/n/~,P ;P <br />1. Is the facility operaatiooal? YES NO <br />a. If not, is there any plan to operate the facility <br />is the future? YES NO <br />b. If so, is there •aa estimate of when? YES NO <br />Date for' start-u±p <br />2. If the facility is operational, is any process or other <br />wastewater being produced? How much? __ gpd YES NO <br />a. If yes, is the w.;ter being treated? <br />b. What form of tre.;tment is utilized? Discuss sizes <br />_ of unit processes sad any chemical additions. <br />c. Ia nay of the process or any other wastewater or <br />water being discharged to waters of the state? <br />(This includes g'coundwater in cases like unlined <br />lagoons.) YES NO <br />1. If yes, identify discharge point(s). <br />d. Is the facility ~iesigned to be a non~ischargiag <br />(evaporative) system. YES NO <br />