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(7) <br />17. Intake and Effluent Characteristics <br />• A. Use the space below to list any of the pollutants listed in <br />Appendix A and 8 which you know or have reason to believe are <br />discharged or may be discharged from any outfall. For every <br />pollutant you list, briefly describe the reasons you believe <br />it to be present and report any analytical data in your posses- <br />sion. <br />18. Is or will land application of any wastewater be prac[iced7 / YES NO <br />If YES, Identify disposal area, crop, specify acreage, quality and quantity <br />. of wastewater, method of application, seasonal operation, pretreatment and <br />groundwater monitoring program. <br />n, <br />19. Estimated life of the activity from which the discharge(s) identified in item <br />12B originate. (~ Years. <br />20. projected treatment costs, life cycle,~including capital and 0 E M expenses <br />for period of permit requested. Attach separate sheet. <br />21. I certify under penalty of law [ha[ I have personaliy examined and am familiar <br />with the information submitted in this application and all attachments and that, <br />based on my inquiry of those individuals immediately responsible for obtaining <br />the information, I believe that the information is true, accurate and complete. <br />I am aware that there are significant penalties for submitting false information, <br />including the possibility of fine and imprisonment. <br />• <br />