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t CITY OF STOCKTON <br /> ® MUNICIPAL UTILITIES DEPARTMENT <br /> REGIONAL WASTEWATER CONTROL FACILITY Septic Tank Truck <br /> 2500 NAVY DRIVE Special Application/Permit <br /> STOCKTON, CALIFORNIA 95206 <br /> (209) 944-8750 For Wastewater Discharge <br /> FAX: (209) 944-8708 i,�,�A h <br /> !� 2 9 sS"9 <br /> ENVIRONMENTAL HE.,,s <br /> PART A — HAULING COMPANVERMIT/SERVICEC. <br /> Applicant Business Name: <br /> Business Address: <br /> Street <br /> City Zip Phone ( ) <br /> Mailing <br /> City Zip Phone ( ) <br /> Name of Owner of Truck: Phone ( ) <br /> Person to be contacted about this application, if other than owner: <br /> Name Phone ( ) <br /> Address (if not above) <br /> Truck Data: <br /> Tank Capacity in Gallons Calif. License No. <br /> Key number issued to you by the RWCF: <br /> San Joaquin County Permit Number: <br /> Certification: I certify that the information above and on the following parts is true and correct to the best of my knowledge. <br /> (Must be signed by officer of company.) <br /> Signature Date <br /> Print Name Title <br /> CITY OF STOCKTON USE ONLY <br /> Da applic tion mailed: Pe i umber: <br /> Date a ation received: N <br /> ker: <br /> Dat ermit ssued: <br /> Permit conditions: Yes No <br /> Expiration Date: <br /> Comments:� , &qS� (f AA M,-� <br /> ` Title �„ L7 <br />