PERMFILE65348

• Permit No: C1981053
• IBM Index Class Name: Permit File
• Doc Date: 12/11/2001
• Section_Exhibit Name: 2.03.4 IDENTIFICATION OF INTEREST
• Media Type: D
• Archive: No

.- .- i ,-
_,
17.
• 18.

(7)
Intake and Effluent Characteristics
i
4. Use the space below to list any of the pollutants listed In '~
Appendix A and B which you know or have reason to believe are '
discharged or may bn discharged from any outfall. For every
pollutant you list, briefly describe the reasons you believe ~
it to be present and report any analytical data in your posses-
sion.
1. POLLUTANT 2. SOURCE 1. POLLUTANT 2.

~ ,i

RCE
t - "4 H I '

li

I ~
i
Is or. will:laad appllca~.Ton of any wastewater be practlced7 YES !.IXI NO
• If YES, Identify disposal area, crop; specify acreage, quality and qu'an~ttty
of wastewater, method of application, seasonal operation, pretreatment hand
groundwater monitoring program. i
_ II
~'
19• Estimated life of the activity from which the discharge(s),ldentlfl.ed,in item
128 or.lginate. 5 Years.
... i
°.
:~jii' ,.
Il
'i,'; I?~
;. ~.
~'
t :~;
,~,.
,''I~
;a'.
i
.~±~''
.is
.,
1'~ ~f~r,
,7,~~~
~..
j ~+
~ 1; ..l
',;
`'Y,
• ,~
i
,.Xi
,' ~~y,i
~.4
', .,,~
' ': I
~(.
20. Projected treatment costs, life cycle,•including capital and~O b M expesns
for period of permit requested. Attach separate sheet.
21. I certify under penalty of law that i have personally examined and am familiar
with the Information submitted in this application and all attachments and that,
based on my inquiry of [hose individuals immediately responsible for obtaining
the information, l believe chat the information is true, accurate and complete.
I am aware [hat there are significant penalties for submitting false information,
including the possibility of fine and imprisonment.
/ •
_ ~ ~ Mnv ~ lnf'r,
A. SIGNATURE B. DATE SIGNED
FI DEL LOBA71~ OWtJI' R
C. NAME (PRINTED) _ __ n_ r~TJE_~~... - '