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MUNICIPAL UTILITIES DEPARTMENT <br /> �C(n OF REGIONAL WASTEWATER CONTROL FACILITY <br /> 2500 NAVY DRIVE (209) 937-8700 PHONE <br /> STOCKTON STOCKTON, CA 95206 (209) 937.8702 FAX <br /> WASTEWATER DISCHARGE PERMIT <br /> PART A- APPLICATION <br /> Return the completed application by: <br /> Al.Applicant Business Name: 5Towm,t.) P(z4Pc1L6'LIN-C . <br /> A2.Address of premise discharging wastewater: <br /> 079 WlUZ)k XP STM97U.11i 9S'}1.�— <br /> Street City Zip <br /> A3.Business/Mailing Address: <br /> SA-�c <br /> Business Address City Zip <br /> SA- E <br /> Mailing Address City Zip <br /> A4.ehtef•Executive-effaer <br /> Wklxr`/ CE1A roLE12 }�RMEIQI� 6wrSL <br /> Name ' Title <br /> ?a I3Lgy sr9:I ;S1 9s2o1 <br /> Mailing Address City State Zip <br /> aL79- 0�?)- 73-1 ao9 - -�SID s <br /> Phone (Office) Phone(Cell) Phone (Fax) <br /> A5.Person to be contacted about this application: <br /> )1' Y-E QELVA-06r%_ �c'(>V1Ct bNkr/l�Gc^� <br /> Name Title <br /> ao5-y8 -- gLxoc UP3 �s-98a- 13�1D <br /> Phone (Office) Phone (Cell) Phone (Fax) <br /> E-mail: YKIKcC° STt)�tU�►�S �lAQctll-�.C$1� <br /> A6.Person to be contacted in case of emergency: <br /> Name Title <br /> a09 - 10 -L)OM a10- (401 -0363 <br /> Day Phone Night Phone <br /> A7.CERTIFICATION: Ice formation above and on the following parts are true and correct to <br /> the best of my kno <br /> Signa ure Date <br /> `N+Ke%�ELywnlf' �jtylGr— LwFN�'1'L <br /> Print Name Title <br />