Form: Discharge Service Information Request - Calleguas Municipal Water District

Name of applicant (discharger)*

Person submitting on behalf of discharger*

Email*

Phone Number*

1. Type of discharge (brine, recycled water, groundwater, etc.)*

2. Attach available analysis of the water quality of the anticipated discharge. (pdf, jpg, png)*

Accepted file types: jpg, jpeg, pdf, png, gif, Max. file size: 25 MB.

3. Attach map of approximate location of desired connection. (pdf, jpg, png)*

Accepted file types: jpg, jpeg, pdf, png, gif, Max. file size: 25 MB.

4. Estimated initial minimum/maximum flow rates*

5. Estimated ultimate minimum/maximum flow rates*

6. Attach a drawing and a brief written description of the facilities that will discharge flows through this service connection. Show major facilities including treatment facilities, pipelines, regulation and control facilities, surge protection equipment, and pumps, with applicable capacities.*

Accepted file types: jpg, jpeg, pdf, png, gif, Max. file size: 25 MB.

7. Is this discharge anticipated to be consistent year-round?*

Yes

8. Can this discharge operation be stopped with the automatic closure of a valve in less than 5 minutes?*

Yes

9. Is flow to be discharged through this service connection to be pumped?*

Yes

10. If flow to be discharged through this service connection is to be pumped, attach a list showing the number of pumps to be employed and the design head discharge characteristic for each pump.

Accepted file types: jpg, jpeg, pdf, png, gif, Max. file size: 25 MB.

11. Will an easement be required for installation, operation and maintenance of a discharge service connection with a footprint of X by X, including vehicular ingress and egress of no less than 20' in width?*

Yes

(If yes, then such easement must be provided by discharger without cost to the District before construction can be bid.)

12. Date of desired initial discharger through this service connection*

13. Anticipated date of ultimate discharge through this service connection*

14. Does the discharger want operational feedback from the CMWD service connection for monitoring and control? No discharger equipment may be mounted in or on the Calleguas control cabinet.*

Yes

15. Does the discharger wish to have local cabinet space provided for communications and other equipment? No discharger equipment may be mounted in or on the Calleguas control cabinet.*