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*aa, 1..W Page 5 <br /> CALIFORNIA ENVIRONMENTAL State of C abfOlraa p�oounces c <br /> PROTECTION AGENCY RegionalWater Quality Control Board <br /> APPLICATIONIREPORT OF WASTE DISCHARGE aaa� <br /> GENERAL INFORMATION FORM FOR <br /> Qa; WASTE DISCHARGE REQUIREMENTS OR NPDES PERMIT <br /> I. FACILITY INFORMATION <br /> A. Facili <br /> Name: <br /> Munn &Perkins <br /> rdd�a: <br /> 26292 East River Road <br /> : : 9i5320 <br /> ty <br /> Escalon SnJoade: <br /> Contact Paxaoa: Telepho¢e N,mher: <br /> Bill Faris (209)524-3197 <br /> B. Facility Owner: <br /> N._ Owner Type (Check One) <br /> George Reed, Inc. 3. ❑ na da l % (] (mxpn u— <br /> Addxeaa: 3. ❑ Governmental 4. ❑ Paztvexship <br /> P.O. Box 4760 ageney <br /> City: Stall: Zip Cade: 5.❑ 0thex: <br /> Modesto CA 95352 <br /> Covtact Pexaon: Telepho�Nmdei: Federal Taz ID: <br /> Bill Faris (209)523-0734 94-1531193 <br /> C. Facility Operator (The agency or business,not the person): <br /> Name: Operator Type (Check One) <br /> "Same As Owner" i.❑ na canal Z. 0 ex w atinn <br /> Mdmas: 3. ❑ Govern®ntal 4. ❑ Paxtoacship <br /> Age¢cy <br /> ��; St3te: Zip Code: <br /> 5. Otben: <br /> Contact Pexaon: Tel6yhone N.mbex: <br /> D. Owner of the Land: <br /> Nam: Type (Check one) <br /> Aggregates, Inc. cemnrat;o¢ <br /> a; 3. ❑ Govemmntal 4. ❑ pextrexship <br /> P.O. Box 3191 <br /> efts: stain: Zip mae: <br /> Modesto CA 95353 s. ❑ o nex: <br /> Co¢tact Paxson: Telephone N®bex: <br /> Wendell Reed (209) 521-9771 <br /> E. Address Where Legal Notice May Be Served: <br /> adaxea.: <br /> "Same As Owner" <br /> City; crate: Zip cede: <br /> (�Gct Petaw: Telephone Nie : <br /> F. Billing Address: <br /> addxea.: <br /> "Same As Owner" <br /> City; sr ra: Zip Code: <br /> Contact Paxson: Telep* N®bax: <br /> Fozm 20016/97) <br />