Page 170 - California Stormwater Workshop Handouts

ATTACHMENT D

PERMIT REGISTRATION DOCUMENTS (PRDS)

Emergency Phone (e.g. 999-999-9999)
E-mail ([email protected])
State/Zip CA
Total Site Size (Acres)
Latitude (Decimal degrees only, minimum 5 significant digits, e.g.
99.99999)
Longitude (Decimal degrees only, minimum 5 significant digits, e.g.
99.99999)
Total Percentage Site Imperviousness Area of Facility (Acres)
Total Areas of Industrial Activities and Materials Exposed to Precipitation
Primary SIC Code
Secondary SIC Code
Tertiary SIC Code
Regional Water Board

c. Billing Information

Billing Name
Contact First Name
Contact Last Name
Title
Street Address
Address Line 2
City/State/Zip
Phone (e.g. 999-999-9999)
E-mail (e.g. [email protected])

d. Receiving Water Information

Does your facility's storm water flow directly or indirectly into waters of the US
such as river, lake, ocean, etc. (check box for directly or indirectly)

i. Indirectly to waters of the US

ii. Storm drain system - Enter owner's name:

iii. Directly to waters of the US (e.g., river, lake, creek, stream, bay,
ocean, etc.)

iv. Name of the receiving water: ____________________________

Order 2014-0057-DWQ 3