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E" Page 5 <br /> CALIFORNIA ENVIRONMENTAL State of California <br /> PROTECTION AGENCY Regional Water Quality Control Board <br /> 0 <br /> APPLICATION/REPORT OF WASTE DISCHARGE 3 �0 <br /> GENERAL INFORMATION FORM FOR rs <br /> WASTE DISCHARGE REQUIREMENTS OR NPDES PERMIT CALf�HN,P <br /> I. FACILITY INFORMATION <br /> A. Facility: <br /> Noma: <br /> Address: NORTH ,OND r2UA G <br /> City: G County: state. Zip Code: <br /> LU D i 5AN.;',)AQ9iA1 (A '15 2 4 <br /> Contact person: Telepboae Numbers <br /> SNA EP- d - Z7 <br /> B. Facility Owner: <br /> Name: Owner Type (Check O$e) <br /> LEL: 4 4 j b "/^u`A de 6�wµ E_ 1. © I--itviA—1 2. ❑ Corporation <br /> Address. I`I -t 3. ❑ Governmental 4. ❑ Partnership <br /> 25'L O Agency <br /> City: State: Zip Code: 5. ❑ Other: <br /> Contact persons Telephone Numbers Paderal Tax IDs <br /> ) Q SNA E 2 (zc�c Z76 T <br /> C. Facility Operator (The agency or business,not the person): <br /> Name: Operator Type (Check One) <br /> �� �� I 1. ❑ Individual 2. [:] Corporation <br /> Address. rr�� 1^�ZV 3. ❑ Governmental 4. E] Partnership <br /> Z32-+72 U N t I`�L)n I/ Agency <br /> City. Btates Zip Code: <br /> I f (s Z Z 5. ❑ Other: <br /> Contact Persons Tel hone ars <br /> R A U LA IVDA �Z z 47 _7P <br /> D. Owner of the Land: <br /> Name, Owner Type (Check One) <br /> 1. ❑ Individual 2. ❑ Corporation <br /> C " ,A "N Cn�T <br /> Address: 3. ❑ Governmental 4. ❑ Partnership <br /> Agency <br /> City: State: Zip Code: <br /> S. ❑ Other: <br /> Contact Person: Telephone Numbers <br /> E. Address Where Legal Notice May Be Served: <br /> Address: .^ <br /> L �RrH [Zo P4 6 P-0n <br /> City: States Zip Code: <br /> t o ! I rA q5242- <br /> Contact <br /> Person:LF- Or: PXAULA Ia v 1 2-v <br /> Telephone Number: , 30 0 _ Z <br /> F. BillingAddress: 4/ <br /> Address: NO2T D <br /> City: �-1 State: Zip Code: <br /> 2100 I CA 61t,24 2- <br /> Contact <br /> Contact Persons Telephone lumbers <br /> / <br /> Form 300(6/97) <br />