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TIM I —ClJ—V V l'J 1. JO f l l Ga... l -IJ 71 070 f 7JY f <br />State of California <br />State Water Resources Control Board <br />NOTICE OF INTENT <br />TO COMPLY WITH THE TERMS OF THE <br />GENERAL PERMIT TO DISCHARGE STORM WATER <br />ASSOCIATED WITH INDUSTRIAL ACTIVITY (WO ORDER No 97-0,DWt7) <br />(Excluding Construction Activities) <br />SECTION I. NOI STATUS i <br />e check only one box) <br />I� A. New Permittee B. [ J Change of Information WDID # I I I <br />SFCTICIN II FAC11 ITY C]PFRATCIR INFC)RMATION tSee instructions) <br />r. i r <br />A NMEr� <br />IQ6 Ifni 6I151u1i I-11)ICIA151, 1 tZ,`wiel. I I I I I I I I <br />I I I I <br />P one: <br />I a31-12l2l,--ILI1p10fl <br />Mailing Address: ii <br />15(/IOloi i&01L161Li e1.4iF, IGKI .I ISI�IeI. 1oZ(/I'I I <br />1 1 I t <br />,2y: �,/ <br />161131 Wltalr<LI�ISI <br />City: <br />IS,TTVIClk1r-101 .1 1 1 1 1 1 1 1 1 1 1 1 1 1, <br />S tate: <br />Zi Code: <br />I 1 1 1 1 1I�IQ <br />B MAILIN�D,DgESS: <br />1241 %f 7 VDD <br />W 1 Ion AAA Tir-i/et <br />I 1 I I 1 I <br />City:./ <br />M I 1 <br />Contact Person: <br />State: <br />c IA <br />B. OPERATOR TYPE: <br />C ntact Person: <br />141 EI T[E1 I U,64l <br />(check one) 1 Al Private 2.[ ]City 3.( ]County 4.[ ]State <br />5.( ]Federal 6.1 ]Special District 7.( ]Gov. Combo <br />SECTION III_ FACII [TV -RITF 1NFf1RKA,&,rinm <br />A. FACILITY NAME 1 <br />Q-6t/t1E181al/Ide-XI Sl, 1 1-77A(Icl I I I I I I, <br />I 1 11 I I <br />Phone: <br />12406)-1 YiiA71-10'1910 <br />Facility Location: <br />IL1 3121 IIA,?. I 16W A7-ie9 Xii ,11/41 I I 1 1 1 <br />I 1 I, 1 I I <br />C unty: <br />MAW iTyldlgA LA jIW 1 1 1 <br />City: <br />IS,TTVIClk1r-101 .1 1 1 1 1 1 1 1 1 1 1 1 1 1, <br />State: <br />C:IA <br />Zip Code: <br />17ts2101G1—I 1 1 1 1 <br />B MAILIN�D,DgESS: <br />1241 %f 7 VDD <br />W 1 Ion AAA Tir-i/et <br />I 1 I I 1 I <br />City:./ <br />M I 1 <br />State: <br />c IA <br />Zip Code: <br />I ZI 51,,21011-1— I I I, I <br />C ntact Person: <br />141 EI T[E1 I U,64l <br />C. FACILITY INFORMATION ( check one) <br />Total Size of Site- Acres Sq. FL <br />'ercent of Site Impervious (including rooftops) <br />I I I I I 131 [ J <br />I I %ISI <br />D. SIC CODE(S) OF REGULATED ACTIVITY: E. REGULATED ACTIVITY (describe each SIC code)),::/ <br />1. 1s oil 101 �IuiT�l/ylol�il�If!ICI <br />Y'IAAfr51 t�l%tll040-1siQi/" <br />2. 1 1 1 1 1 1 1 1 1 1 1 <br />1 1 1 1 1 1 1 1 1 1 1 1 1, 1 1, l l l <br />3.1 1 1 1 1 1 I I 1 1 I <br />i I l 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 <br />