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12. Chemical treatment: Will any flocculants (settling agents or chemical additives) be used to treat water prior to discharge? <br />~ / Nd ~ Yes If,Y~S, list here, and include the Material Safety Data Sheet (MSDS): <br />Chemical Name * Manufacturer Purpose In Which Waste Stream? <br />• If the chemical formula is unknown or confidential, provide the manufacturer's name, contact person, address and phone number or a copy of <br />the manufacturer's brochure, product label, infom~ation or materials handling data sheet for each product used. Please list the major constituents <br />or active ingredient(s), if known <br />13. Are the receiving waters, indicated in item 5, a ditch or storm sewer? <br />~ 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 dischazge pemut does not allow a dischazge into a ditch or municipal storm sewer system without the approval of the owner/operator of <br />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 weir, pump capacity, parshal] flume, <br />etc.)? .. ,. _ _ ~ 1 <br />6 <br />