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i <br />12. Chemical treatment: 'J/ill any flocculants (settling agents or chemical additives) be used to treat water prior to discharge? <br />I <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 fornnda is unknown or confidential, provide the manufacturer's name, contact person, address and phone number or a copy of <br />the manufacturer's hrochure, product label information or materials handling data sheet for each product used. Please list the major constituents <br />or active ingredients I, if known. <br />13. Are the receiving waters, indicated in item 5, a ditch or storm scwer? <br />~ No ~ Yes <br />IfYF.S, submit documentation that the owner of the ditch or storm sewer allows this discharge. No certification will be processed unless <br />docwnentation 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 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: WLat method of flow measuremeut will be used for each discharge point (e.g., v-notch weir, pmnp capacity, parshall flume, <br />etc.)? ~ ,, ~ <br />6 <br />