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NOTICE OF INTENT Page 1 of 4 <br /> � t <br /> APPLICATION and AGREEMENT FOR COVERAGE <br /> FOR MOSQUITO CONTROL UNDER WSDOH'S NATIONAL POLLUTANT <br /> DISCHARGE ELIMINATION SYSTEM GENERAL PERMIT <br /> NOTICE OF INTENT FOR YEAR 2003 <br /> TO COMPLY WITH THE TERMS OF THE STATEWIDE GENERAL NATIONAL <br /> POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)PERMIT FOR <br /> DISCHARGES OF MOSQUITO LARVICIDES TO CONTROL MOSQUITO INFESTATION ON SURFA CE WATERS <br /> OF THE UNITED STATES(GENERAL PERMIT) <br /> For follow-up and end-of-season reporting,please use the following username/password: <br /> USERNAME:NW1895 <br /> PASSWORD:COMP1322 <br /> I. ENTITY&TYPE OF ENTITY <br /> Name : Entity Type : <br /> City of Everett Association <br /> Corporation <br /> X Government Agency <br /> Individual(sole prop.) <br /> Mosquito Control District <br /> Partnership <br /> Other(specify) : <br /> II&III. MAILING AND CONTACT INFORMATION: <br /> Contact Name (if different from entity name) Pesticide Applicator Name <br /> Dan Mathias <br /> Mailing Address Mailing Address <br /> City of Everett Public Works Dept. <br /> 3200 Cedar St <br /> City Zip +4 City Zip + 4 <br /> Everett Wa , 98201 - , 98201 - <br /> E-Mail E-Mail <br /> dmathias@ci.everett.wa.us Daytime Phone No. <br /> Daytime Phone No. ( ) - <br /> (425 ) 257 -8855 Cell Phone No. <br /> 0 - <br /> IV. WATERBODY,LOCATION AND CHEMICAL INFORMATION: <br /> Waterbody WRIA Lat/Long Larvicide, Amount & Larvicde, Acres <br /> Applied Date <br /> / , EPA#- , Gal., Applied On: <br /> All Publicly Owned and CEDAR- Methoprene - Pellet, EPA#- , 560 <br /> Maintained Drainage 47.9792/ <br /> Facilites Inside Everett SAMMAMISH 122.2008 Lbs., Est. Amt., Applied On:5/21/03- .6 <br /> City Limits WRIA-08 11/1/06 <br /> All Publicly Owned and Bacillus sphaericus (H-5a5b) , EPA #- <br /> Maintained Drainage SNOHOMISH 47.9792/ 800 Lbs., Amt., Applied 3 <br /> Facilities Inside Everett WRIA-07 122.2008 On:SEst.st. -11/1/06 <br /> City Limits <br /> IAll Publicly Owned and CEDAR- Bacillus sphaericus (H-5a5b) , EPA #- <br /> 41 <br />