Laserfiche WebLink
SEILN1 t tuitt.1 <br />Title <br />g.(5-1 - 1,t5 - 31.3 <br />SCITY OF <br />STOCKTON <br />MUNICIPAL UTILITIES DEPARTMENT <br />REGIONAL WASTEWATER CONTROL FACILITY <br />2500 NAVY DRIVE (209) 937-8700 PHONE <br />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: <br /> 5r0C.44t,t3 ?az() 611E31_ kr"L . <br />Address of premise discharging wastewater: <br />)y-is wiLcoy, PP STot-Pulu <br />Street City Zip <br />Business/Mailing Address: <br />S pr <br />Business Address <br />S AN--K-E <br />City Zip <br />Mailing Address City Zip <br />et tief-EKecutive-effter <br />(k)tLE"-1 CRA-aDLEY2___ P-ZileArti 61/441•1a1--- <br />Name Title <br />Mailing Address City State Zip <br />d_ 09- cal - 7 3-7 y a09 - ?-01., -75-DS-- <br />Phone (Office) Phone (Cell) Phone (Fax) <br />Person to be contacted about this application: <br />IIMICE 2c-Lvv“,,v7- Setx.V1C:i7 Mirri tr G-01-- <br />Name Title <br />d.(31 - loo <br />Phone (Cell) <br /> <br />Phone (Office) Phone (Fax) <br />E-mail: ETtqqJ RIO c—t-LL--X1-.. (471.A <br />A6. Person to be contacted In case of emergency: <br />r!- twzsc <br />Name <br />09 - 183 -1/000 <br />Day Phone Night Phone <br />A7. CERTIFICATION: I ce formation above and on the following parts are true and correct to <br />the best of my kno <br />Signa ure Date <br />041114-7,i6-t k$44-NAc_tit_. <br />Print Name Title