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_TE O:CALIFORNIA <br /> e ANTME«T OF HEALTH SERVICESCONTROL <br /> AR ASTIE Or 'GEMENT SOARO <br /> APPLICATION FOR <br /> FACILITY PERMITJWASTE DISCHARGE <br /> lOA OFFICE USE UFLY <br /> This form is to be used fol filing a/an: (chink all apptopdate) Form 209 Recd <br /> f.(RW0001_— <br /> 1. REPORT OF WASTE DISCHARGE Codl Let",to <br /> Ipurauent to Diwa.on 7 01 in.S1610 Water <br /> 2,[, APPLICATION FOR A HAZARDOUS WASTE FACILITY PERMIT R.port Rec'e -- <br /> (puna .t to Heahh and S.ratY Cod Section 252901 <br /> 3, n APPLICATION FOR A SOLID WASTE FACILITIES PERMIT Eff�p.,lrEDF tiVt hd <br /> (punu.nt 10 Gntofnt Cod Section 66796.301 <br /> 4. ❑ APPLICATION FOR A RUBBISH DUMP PERMIT Do«S No. <br /> ea <br /> Iponuent to Public RVVO.,CCode Seniooa 4379-4375 end 44361 SWM0 No. <br /> IACaa.ITT <br /> w•«a o. I.uurr <br /> Former Exxon RS 7-3942 a••` <br /> _-_ - --'- 95207 <br /> ...••4444 North Pershing Avenue, Stockton, California T1.e.N... <br /> aN<Na <br /> .N.«• r1l<w•... <br /> NeNa OI elU11Na1e O.Fn Ar IMO I.CILITV <br /> Exxon Company U.S.A. <.•<••• <br /> - - - 77002-4415 <br /> ....... <br /> Smith Street., Room 31123, Houston, Texas <br /> TT.a OI aun Nl ee orlw wflwe I.Cl�r O Corpoution a Ga:Nff1111ef1t AOerICY - <br /> 0 Sob Pmprbtorthip Pertnanhip <br /> {. M.YI Or O.Niw • OI NY1rMa11 OICw wT,M. IIt CII.aTV <br /> Exxon Company ,U.S.A. - I <br /> Z. _..........e..<. 7.,.. 77002-4415 <br /> 1200 Smith Street Room 31123 Houston, Texas <br /> u. wuao«row nu«a <br /> cwac..0.•••e•....a. <br /> G, Clwtg<in lwai,wn oWnti,q 1lcilitY <br /> N1w discherpe or facility D. CMnps>n rJtrcur of ditche" <br /> EMerPnRnt al eaitting/eeilitY <br /> A. E, Ch,in pl<c+or metMd of digocel H. <br /> a. E.inio9 ditcha'w or facility (, Other))whin ylpvl <br /> C, ilacrop in 4umtitY of dieCM,Se <br /> F. Ch«+oe wr detipn or operation <br /> <................... G.®Wppdw=T4 tit. <br /> p, S<we9e tn.lment <br /> A. Trans/ar nation H. off",Solid weaHapw <br /> (awbin below) <br /> diel site E lodustry(on+iu diapo.al facility) Soil and groundwater <br /> S. I.d..atrY(diechitq.to <br /> C. Heaardow ,ante d:wotd sk1 F• <br /> remediation site <br /> -- w. rVla or wwars <br /> c.ec...�• '•e•"^••' 1Conahurt mltarieh <br /> Sewage,tewe9e dud W.and/or E. AiF. 1t--1 Vna <br /> A tapt.c tink oumpirpa J- Ue <br /> peed lnimela <br /> Animal.1,030. 1N ..tlid wenn F' <br /> Fonat prud..ct—t- K. 7frsa <br /> C. Munieiwl solid«watet �'' Vin below) <br /> H. ttuctionldemolition wNM LOd»r at <br /> p. HaxeNouswutat mediated groundwater <br /> c— v. arta oaato«CAIA<aTT < <br /> <. ..--3 5. .. . <br /> . ...............NO 28,800 gpd. _--- <br /> --- --- ---- -- lOVIAI <br />