Design Engineer’s Name, California License Number, address, and phone number
Operation and Maintenance Responsible Engineer’s Name, California License Number, address, and phone number
Name, phone number, and email of the Discharger’s assigned staff to investigate the cause(s) of errors and the corrective actions taken, or date when actions will be completed to eliminate or reduce future data error (applicable if any monitoring data for the sample(s) taken on or after January 1, 2006, were claimed to be invalid)
The maximum discharge rate from the groundwater treatment system shall not exceed _______________ gallons per minute (gpm). The groundwater treatment system is designed for ______________ gpm. I understand this discharge shall not cause pollution, contamination, or nuisance. For example, the discharge shall cause no scouring or erosion at the point where the storm drain or outfall-pipe discharges into the receiving water(s).
Treated water will be discharged through a storm drain to the receiving water(s) described in Table 6 below and shown on the aerial map in Attachment 3.
Complete Table 6. Discharge Location
Discharge Point Location
Discharge Point Latitude
Discharge Point Longitude
A copy of the Order, a complete copy of this Notice of Intent, documentation of the authorization to discharge received from the Regional Water Board, a full copy of the O&M Manual, and any other documents recommended by the engineer or the QA
Attachment B – Notice of Intent FormB-5
Order No. R2-2006-0075, Fuel General NPDES Permit No. CAG912002