Laserfiche WebLink
MUNICIPAL-UTILITIES DEPARTMENT <br /> REGIONAL WASTEWJ,,.,R CONTROL FACILITY <br /> ® 2500 NAVY DRIVE <br /> STOCKTON,CALIFORNIA 95206 <br /> a <br /> (209) 944-8750 <br /> CITY OF STOCKTON (209)944-8760 Part A - Application / Permit <br /> SECTION 1. APPLICATION <br /> Return the completed application by: <br /> Further Instructions: See reverse side. n <br /> Al. Applicant Business Name ARCO def rbL�m P dues C -,twpernIr <br /> A2. Address of promise discharging wastewater: 'Agto Sizes fi`ox �f 3 3 <br /> A. Street 290$ Be,q i a)g7,kt. Half 1Dri✓e <br /> City ,S1-ook4-fri _ e_al;±rnia, zip 'f 07 <br /> A3. Business Address <br /> A. Street 20DO GMo_� C& la--5 81-410a5 <br /> City Saky YL1a4-e_t) 9 C_aji4-pr"i a zip c/4403 <br /> B. Mailing Po5-T OP{ i-c-e Ro X S$/ <br /> City SakL State e 14-- zip q4440 2- <br /> A4. Chief Executive Officer �°ov151ru���n / 7`11ai• eczah�e <br /> A. Name B. Title <br /> C. Mailing Address DO D. CityP16?SQh`kki State 11,4 17ef5-41 to <br /> A5. Person to be contacted about this application (y/fo <br /> A. Name n" P B. Title /n jee- �fll C. Phone 5C_'11-0123 <br /> A6. Person to be contacted in case of eme gM cP1l <br /> A. Name -S & B. Title S - <br /> Day Pho04: N ight Phone `fl `f�`� - 3 b`j <br /> A7. CERTIFICATION : Icertify that the information above and on the following parts is true and correct <br /> to the best of my knowledge. - 1 <br /> ignature J Date <br /> Ne YtrU H.-,/. r5-��F C'C�5I-niLh'CrnZWr7in4touillC.. <br /> Print Name Title <br /> SECTION 2. <br /> CITY OF STOCKTON USE ONLY <br /> Date application mailed Categorical Pretreatment Industry? <br /> Date application received If yes, Federal Code Part? <br /> Date permit issued: SIC Number: <br /> Permit conditions: Yes . No- <br /> Expiration <br /> o .Expiration date Permit fee: $ <br /> Comments: <br /> N <br />