Applicant: Please Complete Sections 1-10

208 CONSISTENCY REVIEW FORM

Douglas A. Ducey, Governor Misael Cabrera, Director APPLICANT: PLEASE COMPLETE SECTIONS 1-9

Application Submittal: Submit application to the 208 Program. Email application to [email protected]; call (602) 771- 4606 for assistance, or go to http://azdeq.gov/environ/water/watershed/regional.html for further information. Along with this completed application, the applicant MUST submit a map with the information noted in item 4 below. Failure to include the map will result in the application being considered incomplete.

Part A. Is your application for any of the following:

A new domestic (publicly or privately owned) Wastewater Treatment Plant (WWTP) An existing domestic (publicly owned or privately owned) WWTP that is adding an AZPDES discharge outfall or changing the location of a previously approved AZPDES discharge outfall More than a 10% increase in permitted design flow Expansion of the service area Change of ownership of a domestic (publicly or privately owned) WWTP (Pima County only) Approval of Sanitary Facilities utilizing on-site wastewater treatment (APP only) If you answered “yes” to any question above, please complete the remainder of this form.

Explanation Part B. Facility Information (Provide a brief description) Name of Owner Name of Applicant 1. Facility Name Contact Phone Number Contact Email Address a. AZPDES (existing or new) b. APP (existing or new) Current surface water discharged to: 2. Permit Type c. If AZPDES, give name of ______surface water receiving the Future surface water discharged to: discharge ______County Latitude/Longitude (for 3. Facility Location AZPDES of the outfall)

a. Facility/site location 4. Attach a map(s) b. Discharge location(s) that includes at a c. Other disposal options minimum d. Service area (for expansion include current and future area) 5. Describe the a. New WWTP facility application action(s) b. New outfall or change in

February 2015 Page 1 of 2 outfall location c. Capacity expansion (million gallons per day (MGD)) d. Expansion of service area e. Change in WWTP checked in Part A. ownership (Pima County only) above. f. Approval of Sanitary Facilities using on-site wastewater treatment systems (APP only) a. Treatment process: Current ______; Future______6. Facility Information b. Design capacity (annual average daily flow): Current______; Future______c. Effluent disposal method: Current:______; Future______

a. Municipal/public utility Name:______Name:______9. What type of entity b. Private utility will operate the c. Semi-public (sanitary facility? district, improvement Name:______district) Explain type: d. Other (explain) Name:______

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