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TEMPORARY WASTEWATER CAPACITY BROKERING APPLICATION Please complete the following application to broker Wastewater Discharge Capacity. When complete, return to: City of Modesto, Water Quality Control Division, by mail at 1221 Sutter Ave., Modesto, CA 95351, by fax to (209) 577-6290 or by email at [EMAIL REDACTED] . Please call the Environmental Compliance Section at (209) 577-6377 with any questions or for assistance in completing the application. Name of Business: Physical Address: Mailing Address: Zip Code: Is this Business connected to the cannery segregation line: Yes ; No Which month and year is the Capacity needed? List amount of Capacity to be brokered in gallons of flow; pounds of BOD And/or TSS: Flow from gallons to gallons ; BOD from lbs. to lbs. ; TSS from lbs. to lbs. Applicant’s signature: Date: Print Applicant’s Name: To be completed by City of Modesto: Is the capacity available? Yes No Where will the Capacity come from? Flow BOD ; TSS Administrative Transaction Fee: $300.00 Invoice Number: Approved By: Date: Print Name and Title: