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<br />AID Number (copy from tom 7 0l form l J
<br />A.u. ednt d nroa N Vle unatuded caeca onN
<br />Approved, OMB No, 2041}0086
<br />Approval explree 5-31.92
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<br />2F
<br />NPDES iced les FFJlvironrtlenWl Protectors Apenry
<br />Wuhinprorl, DC 20160
<br />\~/ EP Application for Permit to Discharge Storm Water
<br />Dischar es Associated with Industrial Actfvf
<br />Paperwork Raductlon Act Nodw
<br />Pudk nportlnp Ourden ldr Mlia application 4 eaamstetl ro average 26.6 noun per application, IndudinQ time for nviewinp inarunions,
<br />warchlnp exla4npp deY ebYfOei, QaalaflnQ and mainWnlnQ tM dale nestled, Nd OOmpIYbrIQ and raVlewlnQ the oollecoion Of inlamatiort. Send
<br />commerce npardlnp die burden eatma4, any other aspsrt of this oollenbn of Inronnaton, or wppseuons for Improving thin lorm, Including
<br />wppeetlona welch may Inaeau a ntluw this burden ro: Chle1, InformWOn Polity &anch, PM•?23, U S. Fnvironmenal Protection /penry, 401
<br />M SL, SW, WeWnpton, DC 70160, or Director, 011ioe of htortnalion and ppularory Aaarn, OHica of Management end Butlpet, Wachmpton, DC
<br />70603.
<br />1. all L tlon
<br />r a udell IIM latltutle entl tors itutla of Its I tion ro the nearest t wcontlc and the name of Ne receivin water.
<br />A Outlall Number
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<br />B. Latitude
<br />C. Lon IWtle D. Reaivinp Water
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<br />Il.lm rovementt:
<br />A Ne you rlow requirW Dy any Federal, Slate, or bcW authority ro meet any implemenuton schedule ror the oonsaucCron, upgrading or
<br />openuon of watuwaur keavnent egwpment a practoes a any otltar environmental proprartu which mry affect Ne diacharpas described
<br />h this application? This Inclutlas, but is not limited ro, permit oondi8ane, adminreuaave a enlwcament orders, anlorcament compliance
<br />achWuN slurs, nipulrions, Doan order, and grant a ben oondi6ons.
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<br />1. Itlendficaaon of Condiaona,
<br />2. AHeaed OvtlWle 4. Fnal
<br />Com lianca Date
<br />reemenu Etc. ~ numWr wura of diachar a 3. Brief Deaal Uon of Pro'ea e. re D. ro'.
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<br />B. Vou may atuch atlditonal ahesu deadibinp any atlditfonel water pollution (or other environmenW projatts which maY aHad your
<br />ws:nmgb.) you now have antler way or which you plan. Indicau wMther each program is now antler way or plannetl, and mtlicau your
<br />•..wblwWannrdbcnbdwecrorooncaud'On.RESEARCHING CLEAN[JP PRt7('; 4~ ONSTII t7 ~
<br />iu Sha Dralna o Ma
<br />Nwcn • bub ramp bhowuly wpo0ltlpny (or intllcahng ma oWme 01 drainage areas eervetl by Na ounall(s) oovved in Na application it a
<br />L.p, yYl.n,c n,Yp a una.udnt.lb) tl4p~con~ the laaety Indudmg: each of tra muse and tlibcharge sUUCluras; me tlrainaga area of each storm
<br />nulu, uullall, p. rbJ n,YUY nnJ LWIJmgb wIIMl1 Ilse tllilOagtl Wtle OI aach slOlm WYltll dYndll, YsCh xnpWll p:wl OI prbbbnl afeab UWd Idr OUItlOOr
<br />,Iwm)b ~r Jaf.O::J Or wyNhcbnl Illalblldlb, baCh tlxlbhng BROC1unl COOYOI meiWfe 10 WCOCe pOllula0li In alOlm Wa1b11000H, md1e11aIG IOatling
<br />bl.U biz.e4 arYUb, aruab whore (resliPUUL. r,erbiGdtlb, x011 Wntl1a00erb and Ibr11I11efb Ue applied, YaCtl 01 IR nlllardOUa Wa519 Iraalmenl,
<br />~r ~iaUb 41 O,Lp06.,1 YL.w 1.uu,.wl,,, 4...e .,~.,,, ,,,.I myunbd to have a NCtiA µrmn which ib usbJ Idr a~t:umulaunp huatdoub W eau under 40
<br />1.I 11 .t.i .t4j, eYlll Wbll YJ IU14 II,aJL hwl, lhb IuClllly nib II IItlQbtl uUUbr~(0u11U, 6pnnQb, ind Uthbl WrldGb water 4JJ,ab wrllCti lUWrvtl ti1Wnl
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<br />n , .. n,. S„ Iq rl .,. ~ Fu.p ~ ~d "1 Conamm on papa 2
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