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MUNlC1*­UT(L.ITIES DEPARTMENT <br /> REGIONAL WASTEWATER CONTROL FACILITY <br /> © 2500 NAVY DRIVE <br /> STOCKTON,CALIFORNIA SS206 <br /> _ ; 9 '6�GP ST C1<=cv � � Part A - Application /Permit <br /> SECTION 1. APPLICATION <br /> Return the completed application by: <br /> Further Instructions: See reverse side. <br /> Al. Applicant Business Name STOCKTON SCAVENGER ASSOCIATION INC. <br /> A2. Address of pre5nj&jHr�qjfflstewater. <br /> A.Street 95206 <br /> City STOCKTON Zip <br /> A3. Business Addr'1AXE <br /> A. Street <br /> City Zip <br /> B. Mailing SAME <br /> City State Zip <br /> A4. Chief Executive Officer <br /> A. Name MIKE SANGIACOMO B. Title CEO/PRESIDENT <br /> C. Mailing Address 1940 NAVY T3RTVF D. City_';j0CKTQN State CA Zip 95106 <br /> A5. Person to be contacted about this application (209) <br /> A. Name ROBERT NEWBURNE B.Title CONTROLLER C. Phone 948-4071 <br /> A6. Person to be contacted in case of emergency <br /> A. Name CARLO JMIANI B_Title OPERATIONS MANAGER <br /> Day Phone 209-474-3460 Night Phone 209-474-3460 <br /> A7. CERTIFICATION; (certify that the informatio above and on the following parts is true and correct <br /> to the best of my knowledge. <br /> Signature Date <br /> ROBERT NEWBURNE CONTROLLER <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 /> No- <br /> Expiration <br /> Permit conditions: Yes— <br /> Expiration date Permit fee: S <br /> Comments: <br /> f <br /> N <br /> n <br /> Q <br />