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Groundwater VOC and Fuel General Permit ORDER NO.R2-2012-0012 <br /> NPDES NO.CAG912002 <br /> Table B-2. Mark or rovide information as a licable <br /> 1 I have contacted the local sanitary sewer agency serving the above address and determined that <br /> dischar in to the local sanita sewer s stem is not a feasible o tion. <br /> 2 I have contacted the local agencies having jurisdiction over the use of the storm drain system or <br /> watercourse and inform them about this ro osed dischar e. <br /> 3 A roximatel ,what ercenta e of the total effluent is reused or will be reused? % <br /> Table B-3. Facili and Professional En ineer s information <br /> Facility Name <br /> 1 Discharger Name <br /> Discharger's Contact Person Name,Mail Address, <br /> Phone number,and Email Address <br /> 2 Authorized Person to Sign&Submit Reports <br /> Billing Information <br /> 3 Contact Person Name,Mail Address,Phone number, <br /> and Email Address <br /> Design Professional Engineer's Name, <br /> California License Number, <br /> 4 Mail Address, <br /> Phone Number,and <br /> Email Address <br /> Operation and Maintenance Professional Engineer's <br /> 5 Name,California License Number, <br /> Mail Address,Phone Number,and <br /> Email Address <br /> Groundwater treatment system design capacity as <br /> 6 certified by Professional Engineer in gallons per minute <br /> m . m <br /> Attach design capacity certification report including <br /> flow schematics showing every components of the <br /> � treatment system to this application.The Professional <br /> Engineer shall affix his/her stamp including signature <br /> and engineering license number to the certification <br /> re ort. <br /> Type of Site or Project. For example:active service <br /> station,closed service station,solvent spills/leaks <br /> 8 active or closed groundwater cleanup sites,short term <br /> dewatering project,long term dewatering Project,or <br /> other( lease ex lain if"other" <br /> Attachment B—NOI Application Form and InstruCtions B_2 <br />