DISCHARGE LOCATION INFORMATION Discharge path to Receiving Water - describe the complete path of the discharge from the exit point of the treatment system to the outfall in the receiving water list streets, land features, and distances as necessary. – Latitude1 Longitude1 Discharge Points Receiving Name Effluent Monitoring Not Applicable (EFF-001 through EFF-n) Drain Not Applicable (if applicable) Receiving Water (directly of via storm drain system) Upstream Receiving At a 50 feet upstream from Water Monitoring the point of discharge into the Location Is access unrestricted? Yes No ☐ ☐ receiving water, or if access is If No, provide details: limited, at the first point (RSW-001U upstream which is accessible. through RSW-nU) Downstream Receiving At a point 50 feet downstream Water Monitoring from the point of discharge into Is access unrestricted? Yes No Location ☐ ☐ the receiving water, or if access If No, provide details: is limited, at the first point (RSW-001D downstream which is accessible. through RSW-nD) Submit latitude and longitude coordinates in decimal degrees with 5 significant figures to the right of the decimal point. □ Check here if information for additional outfalls is attached to this form. TREATMENT SYSTEM INFORMATION A. General Information Groundwater Treatment Design Capacity (gpm) as certified by a Professional Engineer licensed to practice in California. Discharge description (describe discharge and potential pollutants of concern. Attach additional sheets if needed: Discharge Frequency: Continuous Intermittent (explain): ☐ ☐Daily ☐ ☐Emergency Estimated Total Water Reclaimed (%): Type of Reclamation (e.g., dust control): Provide reasons if reclamation is not technically and economically feasible:
DISCHARGE LOCATION INFORMATION Discharge path to Receiving Water - describe the complete path of the discharge from the exit point of the treatment system to the outfall in the receiving water – list streets, land features, and distances as necessary. Discharge Points Latitude1 Longitude1 Receiving Name Effluent Monitoring (EFF-001 through EFF-n) Not Applicable Drain (if applicable) Not Applicable Receiving Water (directly of via storm drain system) Upstream Receiving Water Monitoring Location (RSW-001U through RSW-nU) At a 50 feet upstream from the point of discharge into the receiving water, or if access is limited, at the first point upstream which is accessible. Is access unrestricted? ☐ Yes ☐ No If No, provide details: Downstream Receiving Water Monitoring Location (RSW-001D through RSW-nD) At a point 50 feet downstream from the point of discharge into the receiving water, or if access is limited, at the first point downstream which is accessible. Is access unrestricted? ☐ Yes ☐ No If No, provide details: Submit latitude and longitude coordinates in decimal degrees with 5 significant figures to the right of the decimal point. □ Check here if information for additional outfalls is attached to this form. TREATMENT SYSTEM INFORMATION A. General Information Groundwater Treatment Design Capacity (gpm) as certified by a Professional Engineer licensed to practice in California. Discharge description (describe discharge and potential pollutants of concern. Attach additional sheets if needed: Discharge Frequency: ☐ Continuous ☐Daily ☐ Intermittent ☐Emergency (explain): Estimated Total Water Reclaimed (%): Provide reasons if reclamation is not technically and economically feasible: Type of Reclamation (e.g., dust control):
NOI_VOC_Fuel_GP.docx