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Page 1 <br /> CALIFORNIA ENVIRONMENTAL State of California <br /> — PROTECTION AGENCY <br /> Regional Water Quality Control Board 1 <br /> APPLICATION/REPORT OF WASTE DISCHARGE <br /> GENERAL INFORMATION FORM FOR ; <br /> WASTE DISCHARGE REQUIREMENTS OR NPDES PERMIT `�• �,R^=�^;.•° <br /> A. Facility: I. FACILITY INFORMATION <br /> Name: <br /> Ehlers Family Estate Winery <br /> Addrem: <br /> 9301 W. State Highway 12 <br /> City: County: State: Zip Code: <br /> Lodi ISan Joaquin CA 95242-9435 <br /> Contact Person: Telephone Number. <br /> Steve Ehlers 209-334-5911 <br /> B. Facility_ Owner: <br /> Name: Oamer Type(Check One) <br /> Steve Ehlers IKg Individual 2. ❑ Corporation <br /> Addreo. 3. ❑ Governmental 4. ❑ Parmerahip <br /> 530 S. Mills street Agency <br /> City: State: Zip Code: <br /> S. ❑ Other. <br /> Lodi CA 95242 <br /> _ Contact Person: Telephone Nnmher: Federal Tax 1D: <br /> C. Facility Operator(The agency or business, not the person): <br /> Name: Operator Type(Check One) <br /> Ehlers Family Estate Winery 1. ❑ lndividual 2. C] Corporation <br /> Address: 3. C] Governmental S. 0 Partnership <br /> same as above Agcy <br /> City: State: Zip Code: <br /> 5. ❑ other. <br /> Contact Person: Telephone Number. <br /> Steve Ehlers <br /> D. Owner of the Land: <br /> Name: Owner Type(Check One) <br /> Steve Ehlers IXG Individual 2. I] Corporation <br /> Address: 3. ❑ Governmental i, ❑ P+ttner3hip <br /> same as above Agency <br /> City: - State: Zip Code: <br /> 5. ❑ Other. I <br /> Cantact Person: I Telephone Nnmben <br /> E. Address Where Legal Notice May Be Served, <br /> Address <br /> 9301 W. Highway i2 <br /> City: State: tip Code: <br /> Lodi I CA 95242 <br /> Contact Person: Telephone Number <br /> Steve Ehlers I 209-334-5911 <br /> F Billing Address: <br /> Adana: <br /> _ same as above <br /> City: stat.. Zip Code: <br /> .q <br /> Contact Person: Telephone Number. <br />