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1 • _ • Page 5 <br /> CALIFORNIA ENVIRONMENTAL State of California <br /> PROTECTION AGENCY <br /> Regional Water QualityControl Board Ac , <br /> APPLICATIONIREPORTORT OF WASTE DISCHARGE <br /> GENERAL INFORMATION FORM FOR <br /> WASTE DISCHARGE REQUIREMENTS OR NPDES PERMIT oast <br /> A. Facilit I. FACILITY INFORMATION <br /> Musco Family Olive Company <br /> Addrees, <br /> 17950 Via Nicolo <br /> City: C ty, State: Zip Code. <br /> Tracy San Joaqui CA 95377 <br /> co.taet P.r.cn: Benjamin Hall Telephonethnbery 209.836.4600 <br /> ' B. Facility Owner: <br /> Musco Family Olive Company 1. `rX die 2. <br /> ❑ cozportion <br /> Addz.ae, 3. ❑ Cov.cmental ♦. ❑ P--.hip <br /> 17950 Via Nicolo Agenoy <br /> cicr• scca. <br /> .: <br /> ssp teas. ocher. <br /> ' Tracy CA 95377 C] <br /> Con<act P.reenv T.I.phon. Padersl'ilx ID, <br /> Benjamin Hall 209.836.4600 1 94-1489230 <br /> ' C. Facility Operator(The agency or business,not the person): <br /> Pame, Operator Type (Cheek One) <br /> Same as Facility Owner/Producer 1. ❑ 1 eia 1 T. ❑ Cozporetioa <br /> 1 Addroa, <br /> 3. ❑ Gov.znmental ,. ❑ P.ztmx.hlP <br /> Ag<ncy <br /> city, Stets: Zip Code, <br /> 5 ❑ Othe v <br /> Coata<t P.rsoav Telaphon.t3nbery <br /> D. Owner of the Land: <br /> Pen.. o.n.r Type lch.<tr oa.) <br /> See attached sheet 1. ❑ Tvdiviaal T. ❑ Cotperatioa <br /> ' Addzaee. 3. p 6ov.xmeaeal 1. ❑ P.•r•••r hip <br /> Agency <br /> City, stats, Zip Cod.. <br /> 5. ❑ ether. <br /> Contact Pazeoa. T.lephom Pwob.r, <br /> E. Address Where Legal Notice May Be Served: <br /> ' Mar...: <br /> Same as Facility Owner/Producer <br /> aty: state, Zip Code, <br /> ' emt.ct Perron: T.1ephon.P�mbar. <br /> F. Billing Address: <br /> 3aareas: <br /> Same as Facility Owner/Producer <br /> City, Grate: Zip Code: <br /> contact Pezeon: TelephoneN ezv <br /> FOZm]00(6/9]) <br />