WQ0002829_Staff Review Form_20080827

AQUIFER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM
Date: August 27, 2008
To: ❑ Landon Davidson, ARO-APS ® David May, WaRO-APS
❑ Art Barnhardt, FRO-APS ❑ Charlie.Stehman, WiRO-APS
❑ Andrew Pitner, MRO-APS ❑ Sherri Knight, WSRO-APS
❑ Jay Zimmerman, RRO-APS
b
From: Nathaniel Thozxiburg , Land Application Unit
Telephone: [phone] Fax: [phone]
E-Mail: nthaniel.thornburg_(d�ncmail.net
A. Permit Number: W00002829
B. Owner: KDHW�. LLC
C. Facility/Operation: KDHWWIP
❑ Proposed ® Existing ® Facility ❑ Operation
D. Application:
1. Permit Type: ❑ Animal ❑ Surface Irrigation ❑ Reuse ® H-R Infiltration
❑ Recycle ❑ I/E Lagoon ❑ GW Remediation (ND)
❑ UIC - (5A7) open loop geothermal
For Residuals: ❑ Land App. ❑ D&M ❑ Surface Disposal
❑ 503 ❑ 503 Exempt ❑ Animal
2. Project Type: ❑ New ® Major Mod. ® Minor Mod. ❑ Renewal ❑ Renewal w/ Mod.
E. Comments/Other Information: ❑ I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above -referenced application for your
review, comment, and/or action. Within calendar days, please take the following actions:
® Return a Completed APSARR Form.
❑ Attach Well Construction Data Sheet.
❑ Attach Attachment B for Certification by the LAPCU.
❑ Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office -Aquifer Protection Section contact person
listed above.
RO-APS Reviewer: �—��JDate•
AUG 28 2 )-,)
FORM: APSARR 07/06 Page 1 of 1��'
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