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MUNICIPAL UTILITIES DEPARTMENT <br /> REGIONAL WASTVWTER CONTROL FACILITY <br /> 25V DRIVE <br /> STOCKTON,CALIFORNIAF 95206 <br /> CITY OF STOCKTON (209) 944-8750 <br /> (209) 844-9760 Part A. - Application /Permit <br /> SECTION 1. APPLICATION <br /> CA <br /> Alp <br /> Return the completed application by: <br /> Further Instructions: See reverse side. <br /> Al. Applicant Business Name QIRCUIT WORKS INC <br /> A2. Address of premisedischarging wastewater: 152 FRANK,WEST CIRCLE <br /> A. Street , <br /> City. STOCKTON Zip 9.5,20E <br /> A3. Business Address <br /> A. Street, FRANK WEST CIRCLE , <br /> Citi Zip 95206 <br /> B. Mailing 152 FRANK WEST CTRCTF <br /> City' . S1UCT{i>JN°' State CA Zip - 95206 <br /> A4. Chief Executive Officer <br /> A. Name JAY HANSEN B. Title CED <br /> C. Mailing Address 152 FRANK WEST CIRCLE D. CityON State CA Zip- 95206 <br /> A5. Person to be contacted about this application <br /> A. Name- DAVID HOTsrFTN B.Title-FACTTIF Fn*r TN C. Phone 983-0760. <br /> A6. Person'to be contacted in case of emergency - MANAGER <br /> A. Name W T,TII3 WFTRFTT-raM/nAyn+ HOTSTFTN B. Title-CEMI .AT, PRDCF-9,9 T'Nf TN F F h^ <br /> Day Phone 983-0760 7 983-0760 Night Phone 473--4618/477-6Q20 <br /> AT CERTIFICATION : Icertify that the inforpiation above and 0 e following parts is true and correct <br /> to the best of my knowledge. , <br /> APRIL 10. 1987 <br /> nature Date <br /> Print Name Title <br /> SECTION 2. <br /> CITY OF STOCKTON USE ONLY <br /> Date application mailed Categorical Pretreatment Industry? <br /> Date application receiGed If yes,;Federal Code Part? <br /> Date permit issued: SIC Number: <br /> Permit conditions: Yes_. No_. <br /> Expiration date Permit fee: $ <br /> Comments: <br /> n <br /> 0 <br /> 7 <br />