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(REVISED FEBRUARY 2007) Page 5 <br /> �.. men e <br /> CALIFORNIA ENVIRONMENTAL State of California eee u�cEa e <br /> PROTECTION AGENCY Regional Water Quality Control Board <br /> APPLICATION/REPORT OF WASTE DISCHARGE 6ffi� .ko <br /> L4!N GENERAL INFORMATION FORM FOR <br /> WASTE DISCHARGE REQUIREMENTS OR NPDES PERMIT <br /> A. FaClll I- FACILITY INFORMATION <br /> Name: <br /> Munn & Perkins <br /> Aaaresa: <br /> 26292 East River Road <br /> City: County: state: Zip Code: <br /> Escalon San Joaquin CA 95320 <br /> Contact Pexaon: Telephone N�ex; <br /> Bill Faris (209)524-3197 <br /> B. Facility Owner: <br /> Name: Deni Type (Check One) <br /> George Reed, Inc. 1. 11 lndi aal 2. 0 Cxmporatinn <br /> xddreaa: <br /> 3. 0 Go.ntal 9. 13 eavT etship <br /> P.O. Box 4760 Agency <br /> City: Sete: Zap Cede: 5. E] Other: <br /> Modesto CA 95352 <br /> Contact Pexaon: Telephone Humber: Federal Tax ID: <br /> Bill Faris (209)523-0734 94-1531193 <br /> C. Facility Operator(The agency or business,not the person): <br /> Name; Operate-Type (Check One) <br /> "Same As Owner" 1. ❑ rnaiddoal 2. Cntpnnation <br /> Addxeaa: 3. ❑ Governmental 4. ❑ Paxtnerahip <br /> Agency <br /> city: Statc: Zip Code: <br /> 5. Otl,ex: <br /> Contact Pexaon: Tele hone N,mber: <br /> D. Owner of the Land: <br /> Name; Type (Check One) <br /> Aggregates, Inc. L meth al 2. 2✓ °°`P°xatann <br /> Addxeas: 1.E] Goven,mental 4. ❑ Pa -Ihip <br /> P.O. Box 3191 Agency <br /> City; Sets: Zip Code: <br /> Modesto CA 95353 s. ❑ of e <br /> Coataet Peraoa: Telephone N® : <br /> Wendell Reed 1 (209)521-9771 <br /> E. Address Where Legal Notice May Be Served: <br /> Addteas: <br /> 26292 East River Road <br /> City: Sete: Zip Code: <br /> Escalon CA 95320 <br /> Contact p Zon: Tel hone Nffien: <br /> Kenn Benson 20� 524-3197 <br /> F. Billing Address: <br /> Adtlxeaa: <br /> "Same As Owner" <br /> City: Sets: Zip code: <br /> Contact eereon: Telephone Number: <br /> Foam 200I6/9l� <br />