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MUNICIPAL UTILITIE'S DEPARTMENT <br /> REGIONAL WASTEWATER CONTROL FACILITY <br /> 00RAW 2500 NAVY DRIVE: <br /> STOCKTON CALIFORNIA 95206 <br /> 40 (209) 944-8750 Part A - Application / Permit <br /> ROFST.00KTON (209) 944-8760 <br /> SECTION 1 APPLICATION <br /> Return the completed application by <br /> Further Instructions See reverse side <br /> Al Applicant Business Name Wickland Properties <br /> A2 Address of premise discharging wastewater <br /> A Street 6425 Pacific Ave . <br /> city Stockton Zip <br /> A3 Business Address <br /> A Street 6425 Pacific Ave . <br /> City Stockton ZIP <br /> B Mailing <br /> City State—C.: Zip 95Rr- <br /> A4 Chief Executive Officer President <br /> A Name 'ria o4-x ; - John A. Wickland B Title a3=5 <br /> C Mailing Address P.O. Box 13648 D City Sacramento State CA Zip 95853-4648 <br /> A5 Person to be contacted about this application <br /> A Name George U. Converse B Title P C Phone ( )1 6) 6r, -530C <br /> A6 Person to be contacted in case of emergency <br /> A Name George Converse B Title <br />• Day Phone (916) 668 -5300 Night Phone g - <br /> A7 CERTIFICATION Icertify that the information above and on the following parts is true and correct <br /> to the best of my knowledge 2- <br /> Signature <br /> Signature Date <br /> �j�IrUN 2re�e�' <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 /> Permit fee $ <br /> r-AY164LIUH udlC <br /> Comments <br /> e <br /> N <br /> A <br /> r <br />