Laserfiche WebLink
,•,, ; <br /> !MUNICIPAL UTILITIES DEPARTMENT <br /> REGIONAL WASTEWATER CONTROL FACILITY <br /> 2WO NAVY DRIVE - <br /> STOCKTON.CALIFORNIA QSM <br /> A2# 1 M"era-a750 <br /> tom, K H (;'609)94+05700 Part - A. 7 Application /Permit <br /> SECTION 1. APPLICATION <br /> Return the completed application by: <br /> Further Instructions; See reverse side. <br /> Al. Applicant Business Name V 04 'moi'r 1_5 y S� C_ <br /> A2. .4ddress of premise discharging wastewater: <br /> A.Street 9 t to S . Cfiz OJ TL-n-- sz'• <br /> City 'aToc IGT l7 Zip It i z-OG 1 / 3 J D <br /> A3. Business Address <br /> A. StreetT- <br /> Cityp oc Zip 4 S_2_01_ ^ f 3J a <br /> Ii. MailingECI_ 150X 10-1 <br /> City CAP-500 C ,'T+1 state ✓ zip `� O <br /> A4. ,Chief Executive Officer <br /> A. Name Aa' r-'AUI M rr" B. Title 6 . <br /> C. Mailing Address-P-0 *90' 1677 D. State 0 _Zip-I9%-7dAl <br /> AS. Person to be contacted about this application '76a- <br /> A. Name -AI7L"NUR. Al .SPIA "r4.1 B. Title C. Phe Tf3 <br /> As. Person to be contacted in rase of emergency <br /> A. Name _S0Q I"ICu'L- B. Title <br /> Day Phone?d`I 93 r - -1 Night Phone ^L+ S-E_ <br /> A7. CERTIFICATION : ]certify that the information above and an the following pests is true and orrect <br /> to the best of my knowledge. <br /> 1&g/ 174, I <br /> Signature Date <br /> Print Name Title <br /> SECTION 2. - <br /> CITY OF STOCKTON USE ONLY <br /> Date application mailed Categorical Pretreatment InduStrV <br /> Date application received If yes, Federal Code Part? <br /> Date permit issued: SIC Number: <br /> Permit conditions: Yes_. No_. <br /> Expiration date Permit feet $ <br /> Comments: <br /> I <br /> I <br /> A <br /> 0 <br /> iiE'd <br /> 9NI2I33NI9N3 Unw-so3 Wt19S:80 b6. SS 5nu <br />