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11. Site-specific conditions: <br />a) Dces [his facility have bulk storage of diesel fuel, gasoline, solvents, fertilizer, <br />or other hazardous materials on site? ^ No ®Yes <br />b) Is this operation located within one mile of a landfill, or any mine or mill tailings? ®No ^Yes <br />c) Does the dewatering area have or possibly have groundwater contamination, such as <br />Plumes from leaking underground storage tanks, etc.? ®No ^ Yes <br />If YES for any of these, please show location of the landfill, tailings or possible groundwater contamination on the lora[ion map in item 8 or in <br />the general sketch in item 10. Please explain the location, extent of contamination, and possible effect on the discharges from this Cacility. <br />12. Chemical treatment: Will any flocculants (seining 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 the chemical formula is unknown or confidential, provide the manufacmrer's ttame, contact person, address and phone number or a copy <br />of the manufacturer's brochure, product Zabel information or materials handling data sheet for each product used. Please list the major <br />constituents 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 />doctmentation of approval is received. <br />Note: A discharge permit does not allow a discharge into a ditch or municipal storm sewer system without dte 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 meastrement: What method of flow measurement will be used for each discharge point (e.g., v-notch weir, pump capacity, parshall <br />flume, etc.)? Pump Capacity <br />