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i <br /> IL Site-specific conditions: <br /> a) Does this facility have bulk storage of diesel fuel,gasoline,solvents,fertilizers, No Yes <br /> or other hazardous materials on site? <br /> b) is this operation located within one mile of a landfill,or any mine or mill (ailings? Vdf No Yes <br /> c) Does the dewatenng area have or possibly have groundwater contamination,such as No Yes <br /> plumes from leaking underground storage tanks,etc.? <br /> If YES for any of these,please show location of the landfill,tailings or possible groundwater contamination on the location map in item 9 or in <br /> the general sketch in item 10. Please explain the location,extent of contamination,and possible effect on the discharges from this facility. <br /> 12. Chemical treatment: Will any tlocculants(settling agents or chemical additives)be used to treat water prior to discharge? <br /> No Yes If YES list here,and include the Material Safety Data Sheet(MSDS): <br /> Chemical Name• Manufacturer Purpose In Which Waste Stream? <br /> If Ilse chemical formula is unknown or confidential,provide the manufacturer-s name,contact person,address and phone number or a copy of the manufacturer-s <br /> brochure,product label infomtatio t or materials handling data sheet for each product used. Please list the majoc canstituents or active ingredient(s),if known. <br /> 13. Are the receiving waters,indicated in item 5,a ditch or storm sewer? <br /> if No Yes <br /> If YES,submit documentation that the owner of the ditch or storm sewer allows this discharge. No certification will be processed unless <br /> documentation of approval is received. <br /> Note: A discharge permit does not allow a discharge into a ditch or municipal storm sewer system without the approval of the owner/operator <br /> of that system. Please provide documentation of approval from the ditch company or owner of the storm sewer for all new discharges. <br /> 14. Flow measurement: What method of flow measurement will be used for each discharge point(e.g.,v-notch <br /> weir,pump capacity,parshall flume,etc.)? PUMP CAPACITY <br /> SAND AND GRAVEL 5/93 3 <br />