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' • • Page CALIFORNIA ENVIRONMENTAL State Of California eouncaa PROTECTION AGENCY Regional Water Quality Control Board Ae APPLICATION/REPORT OF WASTE DISCHARGE GENERAL INFORMATION FORM FOR oA WASTE DISCHARGE REQUIREMENTS OR NPDES PERMIT a pon ,P A. F&Clh I• FACILITY INFORMATION Name: French Camp Grain Elevator Groundwater Remediation Ana see 9504 South Harlan Road ' City: County: State: Zip Code: French Camp San Joaquin CA 95231 Contact Person: Linda Huff Telephone Mmber:708-579-5976 B. Facility Owner: Name: Owner Type (Check One) ContiGroup Companies, Inc. 1. ❑ rndi'.lanal 2. p Corporation 1 Address: 3. ❑ Oove mental 4. ❑ Partnership 277 Park Avenue Agency City: State: Zip Code: 5. ❑ Other: New York NY 10172 Contact Person: Telephone Number: Federal Tax ID: Dan Decker, V.P. 212-207-5301 36-0947870 C. Facility Operator (The agency or business,not the person): Name: Operator Type (Check One) ContiGroup Companies, Inc. 1. ❑ nriiVim,al 2. p Corporation Address: 3. ❑ Oover�ental 9. ❑ Paxtnerehip 277 Park Avenue Agency city: New York wsit[a'te: Zip Code: t Contact Person: 1V 1 Tl ephon2 Number: ❑ Other: Dan Decker, V.P. 212-207-5301 D. Owner of the Land: Norma: French Camp Grain Elevators, LLC 1. TaeFidsa k One) p Corporation Address:9504 South Harlan Road 3. ❑ Oovarnmental 4. ❑ Partnership Agency City; State: Zip Code: French Camp CA 95231 5. ❑ other: Content Person; Telephone Number: Tim Grunsky 209-465-5871 E. Address Where Legal Notice May Be Served: Address' ContiGroup Companies, Inc. 277 Park Avenue City: State: Zip Cade: ' New York NY 1 10172 Contact Person: Dan Decker, V.P. Telephone Number:212-207-5301 F. Billing Address: "'ContiGroup Companies, Inc. 277 Park Avenue City: New York State: Zip Code: NY 10172 Contact Person:Dan Decker, V.P. Telephone Number:212-207-5301 Form 20016/911