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MUNICIPAL UTILITIES DEPARTMENT <br /> REGIONAL WASTEWATER CONTROL FACILITY <br /> 2500 NAVY DRIVE <br /> STOCKTON CALIFORNIA 95206 <br /> (209) 944-8750 Y OF Part A - Application / Permit <br /> STOCK�'ON (209} 9aa-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._ r-n Zip 958q .q 4642 <br /> A4 Chief Executive Officer <br /> A Name John Mar owski B Titie fans <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 L. Converse B Title Project Geologzst C Phone (215) 66 —5300 <br /> A6 Person to be contacted in case of emergency <br /> A Name. George Converse B Title Project Geoloa at <br /> Day Phone (916) 668-5300 Night Phone (916) 568-5-300 <br /> OA7 CERTIFICATION Icertify that the information above and on the following parts is true and correct <br /> to the best of my knowledge <br /> Signature Date <br /> Print Name Title <br /> SECTION 2 <br /> CITY OF STOCKTbN 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 /> E�^;rat;on nate Permit fee $ <br /> ^r <br /> Comments <br /> V <br /> 0 <br />