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Please print or type In the unshaded era <br />APPENDIX C <br />i. OMB No. 2044008G <br />Approval expires 531-92 <br />Form <br />2F <br /> <br />NPDES United States Environmental Protection Agenry <br />\r, EP~ Washington, DC 20460 <br />Application for Permit to Discharge Storm Water <br />Dischar es Associated with Industrial Activi <br />Paperwork F4ductlon Act Notlea <br />Public reporting burden roc this application is estimated ro average 28.6 hours per application, including time for reviewing instructions, <br />searching existing data sources, gathering end maintaining the dam needed, and completing and reviewing the collection of information. Send <br />commenm regarding the burden estimate, any other espeq of this collection o} information, or sup estiona for improving this form, inGuding <br />sugggestions which may Increase or reduce this burden ro: Chief, Inlormetion Policy &anch, PM-223, U S. Environmenal Protection henry, 401 <br />M St., SW, Washington, DC 20460, or Director, Ottioe of Inronnation and Repularory Affairs, Office of Management and Butlget, Washington, DC <br />20603. <br />I. Otttfall Location <br />For each outtall list the latitude end Ion nude of im location to the nearest 15 seconds and the name of the reCeivin water. <br />A Outtall Number <br />ist <br />B. Latitude <br />C. Lon nude D. Receiving Water <br />name <br /> <br />SEE SECTION 2 OF T E PRE IOUS PPLIC TION <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Il.lm covenants <br />A foe you now required by any Federal, Smte, or local authority to meet any implemenmtion schedule for the construction, upgrading or <br />operation of wastewater treatment equipment or pradiCea or any other environmenal programs which may affect the discharges described <br />in this applieation7 This includes, but is not limited to, permit conditions, administrative or enforcement orders, enforcement compliance <br />schedule letters, stipulations, court orders, end grantor loan conditonc. <br /> <br />t. Identification of Conditions, <br />2. Affected Outtalls a. Final <br />Com fiance Date <br />reements, Etc. number source of dischar a 3. Brief Descri tion of Pro act a. re b. ro'. <br /> <br />DISCHARGE COVERED B STO ATER PERMIT N0. <br /> EMENT PLAN <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />B. Vou may attach additional sheen describing any additional wafer pollution (or other environmental projects which may affect your <br />discharges) you now have untler way or which you plan. Indicate whether each program is now under way or planned, and intlicate your <br />actual or planned schedules for construction. <br />III. Site Dralna a Ma <br />Attach a site map showing topography (or indicating the outline of drainage areas served by the cattail(s) covered in the application it a <br />topographic map is unavailable) depicting the facility including: each of its inmke and discharge structures; the drainage area of each storm <br />water cattail; pavatl areas and buildings within the drainage area of each storm water cattail, each known past or present areas used for outdoor <br />storage or disposal of significant materials, each existing structural control measure to reduce pollumnm in storm water runoff, materials loading <br />and access areas, areas where pesticides, herbicides, soil conditioners and fertilizers are applied; each of im hazardous waste treatment, <br />storage or disposal unim (including each area not required to have a RGRA permit which is used for accumulating hazardous waste under 40 <br />CFR 262.34); each well where fluids from the facility ere injected underground; springs, antl other surtace water bodies which receive storm <br />water dischar es from the tacili <br />EPA Form 3510-2F (Rev. 1-82) Page 7 013 Continue on Pape 2 <br />