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01272004 14:16 E.E C. � 12094683433 <br />NO. 029 P06 <br />r <br />CITY OF STOCKTON <br />MUNICIPAL UTILITIES DEPARTMENT <br />AD REGIONAL WASTEWATER CONTROL FACILITY Septic Tank Truck <br />2500 NAVY DRIVE Special Application/Permit <br />STOCKTON, CALIFORNIA 96206 <br />(208)9376760 For Wastewater Discharge <br />FAX: (208) 837.8708 <br />PART C — DISCHARGE INFORMATION <br />Substances Proposed to be Discharged — Give common and technical names of any materials proposed to be discharged. Bristly <br />Aaersiha tha nhvelral and ehemlcal erooenles of each substance and product. Include Laboratory Analysis and Material Safety Data Shasta. <br />NAME DESCRIPTION <br />QUANTITY 6411oda <br />E <br />J. 00 3 <br />i2 r.• <br />CO UENTS <br />WC—PCODE <br />AI Ickes' <br />FORMA <br />Formaldehyde <br />RAD <br />RadloecIlV <br />Discharge Information — Number of batch discharges: I per morithlday (circle one) <br />Time of batch discharges: ---, at <br />(ap of wuq (HouA M cry! <br />Average quantity per batch: <br />Wastewater Conaltutents — indicate If any of the following constituents, characteristics or substances Is or can be presem (X) In your <br />wastewater diacharee. <br />the Chemical Compounds or Elements (Include Laboratory Analysis) <br />— 1.M V <br />f.H <br />gra <br />Comments <br />MIN., I ImnIA RAII,1 nr AnmLSnlld Weete■ — List the Was and volume of Ilould waste removed from the premises. <br />DESCRI L SITE <br />CO TITUENTB <br />E <br />CONSTITUENTS <br />CODE <br />CO UENTS <br />WC—PCODE <br />AI Ickes' <br />FORMA <br />Formaldehyde <br />RAD <br />RadloecIlV <br />AL <br />Aluminum <br />HC <br />Hydrocarbons, <br />BE <br />Selenium <br />NH3N <br />Amm nla <br />I. <br />Iodide <br />AG <br />Silver <br />SB <br />Antimony <br />FE <br />Iran <br />NA <br />Sodium <br />AS <br />A <br />884 <br />SOLY <br />Solvents' <br />BA <br />Bsrium <br />MO <br />Ma rtesium <br />804o <br />Suilete <br />BE <br />Beryllium <br />MN <br />Manganese <br />8.T <br />Sulfide <br />8 <br />Boron <br />HD <br />Mercury <br />803 <br />Sullte <br />as. <br />Bromide <br />MO <br />Molybdenum <br />MBAB <br />I Surfactants MIBAS <br />Co <br />Cadmium <br />NI <br />Nickel <br />TEMP <br />I Tem ereturs <br />CA <br />Calcium <br />OW M <br />011 8 Greece Min. Orl . <br />CL2 <br />Chlorine <br />0&0 T <br />Oil S Greene I - <br />TI <br />Titanium <br />CL <br />Chloride <br />PESTC <br />Peaticides' <br />SN <br />Tin <br />CR <br />Chromium <br />PH <br />DH Increaae r <br />V <br />Venaoucn <br />CD <br />Cobalt <br />PH <br />PH Decrease — <br />TVA <br />Us—ft Acute <br />CU <br />Cooper <br />PHENL <br />Phenols <br />ZN <br />Zine <br />CN <br />Cyanide <br />P <br />Phosphorus <br />N <br />TMeI Nit en <br />F11 <br />Fluoride <br />K <br />Pateeelum <br />C <br />Crosols' <br />the Chemical Compounds or Elements (Include Laboratory Analysis) <br />— 1.M V <br />f.H <br />gra <br />Comments <br />MIN., I ImnIA RAII,1 nr AnmLSnlld Weete■ — List the Was and volume of Ilould waste removed from the premises. <br />DESCRI L SITE <br />